Compositions and methods for inhibiting expression of transthyretin

ABSTRACT

The invention relates to a double-stranded ribonucleic acid (dsRNA) targeting a transthyretin (TTR) gene, and methods of using the dsRNA to inhibit expression of TTR.

CROSS REFERENCE TO RELATED APPLICATIONS

This application is a continuation of U.S. patent application Ser. No.12/582,669, filed Oct. 20, 2009 which claims the benefit of U.S.Provisional Application Ser. No. 61/106,956, filed Oct. 20, 2008; U.S.Provisional Application Ser. No. 61/115,738, filed Nov. 18, 2008; U.S.Provisional Application Ser. No. 61/156,670, filed Mar. 2, 2009; U.S.Provisional Application Ser. No. 61/185,545, filed Jun. 9, 2009; U.S.Provisional Application Ser. No. 61/242,783, filed Sep. 15, 2009; andU.S. Provisional Application Ser. No. 61/244,794, filed Sep. 22, 2009,all of which are incorporated herein by reference, in their entirety,for all purposes.

FIELD OF THE INVENTION

The invention relates to a double-stranded ribonucleic acid (dsRNA)targeting a transthyretin (TTR) gene, and methods of using the dsRNA toinhibit expression of TTR.

REFERENCE TO SEQUENCE LISTING

This application includes a Sequence Listing submitted electronically asa text file named 20235_sequence_listing.txt, created on Feb. 28, 2012,with a size of 322,910 bytes. The sequence listing is incorporated byreference.

BACKGROUND OF THE INVENTION

Transthyretin (TTR) is a secreted thyroid hormone-binding protein. TTRbinds and transports retinol binding protein (RBP)/Vitamin A, and serumthyroxine (T4) in plasma and cerebrospinal fluid.

Both normal-sequence TTR and variant-sequence TTR cause amyloidosis.Normal-sequence TTR causes cardiac amyloidosis in people who are elderlyand is termed senile systemic amyloidosis (SSA) (also called senilecardiac amyloidosis (SCA)). SSA often is accompanied by microscopicdeposits in many other organs. TTR mutations accelerate the process ofTTR amyloid formation and are the most important risk factor for thedevelopment of clinically significant TTR amyloidosis (also called ATTR(amyloidosis-transthyretin type)). More than 85 amyloidogenic TTRvariants are known to cause systemic familial amyloidosis. The liver isthe major site of TTR expression. Other significant sites of expressioninclude the choroid plexus, retina and pancreas.

TTR amyloidosis manifests in various forms. When the peripheral nervoussystem is affected more prominently, the disease is termed familialamyloidotic polyneuropathy (FAP). When the heart is primarily involvedbut the nervous system is not, the disease is called familialamyloidotic cardiomyopathy (FAC). A third major type of TTR amyloidosisis called leptomeningeal/CNS (Central Nervous System) amyloidosis.

Double-stranded RNA molecules (dsRNA) have been shown to block geneexpression in a highly conserved regulatory mechanism known as RNAinterference (RNAi). WO 99/32619 (Fire et al.) disclosed the use of adsRNA of at least 25 nucleotides in length to inhibit the expression ofgenes in C. elegans. dsRNA has also been shown to degrade target RNA inother organisms, including plants (see, e.g., WO 99/53050, Waterhouse etal.; and WO 99/61631, Heifetz et al.), Drosophila (see, e.g., Yang, D.,et al., Curr. Biol. (2000) 10:1191-1200), and mammals (see WO 00/44895,Limmer; and DE 101 00 586.5, Kreutzer et al.).

U.S. 20070207974 discloses functional and hyperfunctional siRNAs. U.S.20090082300 discloses antisense molecules directed against TTR. U.S.Pat. No. 7,250,496 discloses microRNAs directed against TTR.

SUMMARY OF THE INVENTION

In one embodiment, the invention provides a double-stranded ribonucleicacid (dsRNA) for inhibiting expression of transthyretin (TTR), whereinsaid dsRNA comprises a sense strand and an antisense strand, theantisense strand comprising a region complementary to a part of a mRNAencoding transthyretin (TTR), wherein said region of complementarity isless than 30 nucleotides in length and the antisense strand comprises 15or more contiguous nucleotides of SEQ ID NO:170, SEQ ID NO:450, SEQ IDNO:730, or SEQ ID NO:1010. In a related embodiment, the sense strandcomprises 15 or more contiguous nucleotides of SEQ ID NO:169, SEQ IDNO:449, SEQ ID NO:729, or SEQ ID NO:1009. In yet another relatedembodiment, the sense strand consists of SEQ ID NO:449 and the antisensestrand consists of SEQ ID NO:450. In yet another related embodiment, thesense strand consists of SEQ ID NO:729 and the antisense strand consistsof SEQ ID NO:730. In still another related embodiment, the sense strandconsists of SEQ ID NO:1009 and the antisense strand consists of SEQ IDNO:1010. In yet another related embodiment, the dsRNA comprises a sensestrand selected from Tables 3A, 3B, 4, 6A, 6B, 7, and 16, and anantisense strand selected from Tables 3A, 3B, 4, 6A, 6B, 7, and 16.

In certain embodiments, the region of complementarity between theantisense strand of the dsRNA and the mRNA encoding transthyretin is 19nucleotides in length. In another embodiment, the region ofcomplementary consists of SEQ ID NO:169. In other embodiments, eachstrand of the dsRNA is 19, 20, 21, 22, 23, or 24 nucleotides in length.In still another embodiment, each strand is 21 nucleotides in length.

In certain embodiments, the dsRNA for inhibiting expression oftransthyretin does not cleave a TTR mRNA between the adenine nucleotideat position 637 of SEQ ID NO:1331 and the guanine nucleotide at position638 of SEQ ID NO:1331. In other embodiments, the dsRNA cleaves a TTRmRNA between the guanine nucleotide at position 636 of SEQ ID NO:1331and the adenine nucleotide at position 637 of SEQ ID NO:1331. In certainembodiments, the dsRNA anneals to a TTR mRNA between the guaninenucleotide at position 628 of SEQ ID NO:1331 and the uracil nucleotideat position 646 of SEQ ID NO: 1331.

In still other related embodiments, the invention provides dsRNA asdescribed above for inhibiting expression of transthyretin wherein thedsRNA comprises one or more modified nucleotides. In relatedembodiments, at least one modified nucleotide (or nucleotides) is chosenfrom the group consisting of: a 2′-O-methyl modified nucleotide, anucleotide comprising a 5′-phosphorothioate group, and a terminalnucleotide linked to a cholesteryl derivative or dodecanoic acidbisdecylamide group. In another related embodiment, the modifiednucleotide is chosen from the group of: a 2′-deoxy-2′-fluoro modifiednucleotide, a 2′-deoxy-modified nucleotide, a locked nucleotide, anabasic nucleotide, 2′-amino-modified nucleotide, 2′-alkyl-modifiednucleotide, morpholino nucleotide, a phosphoramidate, and a non-naturalbase comprising nucleotide. In certain embodiments, the dsRNA comprisesat least one 2′-O-methyl modified nucleotide.

In other embodiments, a dsRNA as described above for inhibitingexpression of transthyretin is conjugated to a ligand, or formulated ina lipid formulation. In certain embodiments, the lipid formulation maybe a LNP formulation, a LNP01 formulation, a XTC-SNALP formulation, or aSNALP formulation. In related embodiments, the XTC-SNALP formulation isas follows: using 2,2-Dilinoleyl-4-dimethylaminoethyl-[1,3]-dioxolane(XTC) with XTC/DPPC/Cholesterol/PEG-cDMA in a ratio of 57.1/7.1/34.4/1.4and a lipid:siRNA ratio of about 7. In still other related embodiments,the sense strand of the dsRNA consists of SEQ ID NO:1009 and theantisense strand consists of SEQ ID NO:1010, and the dsRNA is formulatedin a XTC-SNALP formulation as follows: using2,2-Dilinoleyl-4-dimethylaminoethyl-[1,3]-dioxolane (XTC) with aXTC/DPPC/Cholesterol/PEG-cDMA in a ratio of 57.1/7.1/34.4/1.4 and alipid:siRNA ratio of about 7. Alternatively, a dsRNA such as thosedescribed above can be formulated in a LNP09 formulation as follows:using XTC/DSPC/Chol/PEG₂₀₀₀-C14 in a ratio of 50/10/38.5/1.5 mol % and alipid:siRNA ratio of about 11:1. In another variation, the dsRNA isformulated in a LNP11 formulation as follows: usingMC3/DSPC/Chol/PEG₂₀₀₀-C14 in a ratio of 50/10/38.5/1.5 mol % and alipid:siRNA ratio of about 11:1. In still another embodiment, the dsRNAis formulated in a LNP09 formulation or a LNP11 formulation and reducesTTR mRNA levels by about 85 to 90% at a dose of 0.3 mg/kg, relative to aPBS control group. In yet another embodiment, the dsRNA is formulated ina LNP09 formulation or a LNP11 formulation and reduces TTR mRNA levelsby about 50% at a dose of 0.1 mg/kg, relative to a PBS control group. Inyet another embodiment, the dsRNA is formulated in a LNP09 formulationor a LNP11 formulation and reduces TTR protein levels in adose-dependent manner relative to a PBS control group as measured by awestern blot. In yet another embodiment, the dsRNA is formulated in aSNALP formulation as follows: using DlinDMA with aDLinDMA/DPPC/Cholesterol/PEG2000-cDMA in a ratio of 57.1/7.1/34.4/1.4and a lipid:siRNA ratio of about 7.

In certain embodiments, the invention provides a dsRNA such as thosedescribed above for inhibiting expression of transthyretin, whereinadministration of the dsRNA to a cell results in about 95% inhibition ofTTR mRNA expression as measured by a real time PCR assay, wherein thecell is a HepG2 cell or a Hep3B cell, and wherein the concentration ofthe dsRNA is 10 nM. In related embodiments, administration of the dsRNAto a cell results in about 74% inhibition of TTR mRNA expression asmeasured by a branched DNA assay, wherein the cell is a HepG2 cell or aHep3B cell, and wherein the concentration of the dsRNA is 10 nM. Inother related embodiments, the dsRNA has an IC50 of less than 10 pM in aHepG2 cell, wherein the concentration of the dsRNA is 10 nM. In stillother related embodiments, the dsRNA has an ED50 of about 1 mg/kg. Instill other related embodiments, administration of the dsRNA reduces TTRmRNA by about 80% in cynomolgus monkey liver, wherein the concentrationof the dsRNA is 3 mg/kg. In still other related embodiments,administration of the dsRNA does not result in immunostimulatoryactivity in human peripheral blood mononuclear cells (PBMCs) as measuredby IFN-alpha and TNF-alpha ELISA assays. In still other relatedembodiments, administration of the dsRNA reduces liver TTR mRNA levelsby about 97% or serum TTR protein levels by about 90%, wherein theconcentration of the dsRNA is 6 mg/kg. In still other relatedembodiments, administration of the dsRNA reduces liver TTR mRNA levelsand/or serum TTR protein levels up to 22 days, wherein the concentrationof the dsRNA is 6 mg/kg or 3 mg/kg. In still other related embodiments,the dsRNA suppresses serum TTR protein levels up to day 14post-treatment when administered to a subject in need thereof at 1 mg/kgor 3 mg/kg. In still other related embodiments, the dsRNA reduces TTRexpression by 98.9% in a Hep3B cell at a concentration of 0.1 nM asmeasured by real-time PCR. In still other related embodiments, the dsRNAreduces TTR expression by 99.4% in a Hep3B cell at a concentration of 10nM as measured by real-time PCR.

In other embodiments, the invention provides a double-strandedribonucleic acid (dsRNA) for inhibiting expression of transthyretin(TTR), wherein said dsRNA comprises a sense strand and an antisensestrand, the antisense strand comprising a region complementary to a partof a mRNA encoding transthyretin (TTR), wherein said region ofcomplementarity is less than 30 nucleotides in length and wherein thedsRNA comprises a sense strand selected from Tables 3A, 3B, 4, 6A, 6B,7, and 16, and an antisense strand selected from Tables 3A, 3B, 4, 6A,6B, 7, and 16.

In another embodiment, the invention provides a double-strandedribonucleic acid (dsRNA) for inhibiting expression of transthyretin(TTR), wherein said dsRNA comprises an antisense strand comprising aregion complementary to 15-30 nucleotides of nucleotides 618-648 of SEQID NO: 1331 and wherein said antisense strand base pairs with theguanine at position 628 of SEQ ID NO:1331.

In certain embodiments, the invention provides a cell containing any ofthe dsRNAs described in the Summary, above. In certain otherembodiments, the invention provides a vector comprising a nucleotidesequence that encodes at least one strand of any of the dsRNAs describedin the Summary, above. In certain embodiments, the vector is in a cell.

In other embodiments, the invention provides a pharmaceuticalcomposition for inhibiting expression of a TTR gene comprising any ofthe dsRNAs described in the Summary, above, and a pharmaceuticallyacceptable carrier. In related embodiments, the invention provides apharmaceutical composition for inhibiting expression of a TTR genecomprising a dsRNA and a SNALP formulation, wherein the dsRNA comprisesan antisense strand which is less than 30 nucleotides in length andcomprises 15 or more contiguous nucleotides of SEQ ID NO:170, SEQ IDNO:450, SEQ ID NO:730, or SEQ ID NO:1010, and wherein the SNALPformulation comprises DlinDMA, DPPC, Cholesterol and PEG2000-cDMA in aratio of 57.1/7.1/34.4/1.4 respectively.

In yet another embodiment, the invention provides a method of inhibitingTTR expression in a cell, the method comprising: (a) contacting the cellwith any of dsRNAs described in the Summary, above; and (b) maintainingthe cell produced in step (a) for a time sufficient to obtaindegradation of the mRNA transcript of a TTR gene, thereby inhibitingexpression of the TTR gene in the cell.

In yet another embodiment, the invention provides a method of treating adisorder mediated by TTR expression comprising administering to a humanin need of such treatment a therapeutically effective amount of any ofthe dsRNAs describe in the Summary, above. In related embodiments, thedsRNA is administered to the human at about 0.01, 0.1, 0.5, 1.0, 2.5, or5.0 mg/kg. In yet another related embodiment, the dsRNA is administeredto the human at about 1.0 mg/kg. In yet another related embodiment, thehuman being treated has transthyretin amyloidosis, and/or a liverdisorder. In a related embodiment, the human is further provided a livertransplant. In yet another embodiment, administration of the dsRNAreduces TTR mRNA by about 80% in human liver, wherein the concentrationof the dsRNA is 3 mg/kg. In yet another related embodiment,administration of the dsRNA does not result in immunostimulatoryactivity in the human as measured by IFN-alpha and TNF-alpha ELISAassays. In yet another related embodiment, administration of the dsRNAreduces liver TTR mRNA levels by about 97% or serum TTR protein levelsby about 90%, wherein the concentration of the dsRNA is 6 mg/kg. In yetanother related embodiment, administration of the dsRNA reduces liverTTR mRNA levels and/or serum TTR protein levels up to 22 days, whereinthe concentration of the dsRNA is 6 mg/kg or 3 mg/kg. In yet anotherrelated embodiment, the dsRNA is formulated in a LNP09 formulation asfollows: using XTC/DSPC/Chol/PEG₂₀₀₀-C14 in a ratio of 50/10/38.5/1.5mol % and a lipid:siRNA ratio of about 11:1. In yet another relatedembodiment, the dsRNA is formulated in a LNP11 formulation as follows:using MC3/DSPC/Chol/PEG₂₀₀₀-C14 in a ratio of 50/10/38.5/1.5 mol % and alipid:siRNA ratio of about 11:1. In yet another related embodiment, thedsRNA is formulated in a LNP09 formulation or a LNP11 formulation andreduces TTR mRNA levels by about 85 to 90% at a dose of 0.3 mg/kg,relative to a PBC control group. In yet another related embodiment, thedsRNA is formulated in a LNP09 formulation or a LNP11 formulation andreduces TTR mRNA levels by about 50% at a dose of 0.1 mg/kg, relative toa PBC control group. In still another related embodiment, the dsRNA isformulated in a LNP09 formulation or a LNP11 formulation and reduces TTRprotein levels in a dose-dependent manner relative to a PBC controlgroup as measured by a western blot. In still another relatedembodiment, administration of the dsRNA suppresses serum TTR proteinlevels up to day 14 post-treatment when administered to human at 1 mg/kgor 3 mg/kg. In still another related embodiment, the dsRNA is formulatedin a SNALP formulation as follows: using DlinDMA with aDLinDMA/DPPC/Cholesterol/PEG2000-cDMA in a ratio of 57.1/7.1/34.4/1.4and a lipid:siRNA ratio of about 7.

In another embodiment, the invention provides the use of a dsRNA fortreating a disorder mediated by TTR expression comprising administeringto a human in need of such treatment a therapeutically effective amountof any of the dsRNAs described in the Summary, above. In relatedembodiments, the dsRNA is administered to the human at about 0.01, 0.1,0.5, 1.0, 2.5, or 5.0 mg/kg. In a particular related embodiment, thedsRNA is administered to the human at about 1.0 mg/kg. In anotherrelated embodiment, the human has transthyretin amyloidosis, and/or aliver disorder. In yet another embodiment of the use provided by theinvention, the treated human is further provided a liver transplant.

In yet another embodiment, the invention provides the use of a dsRNA ina method for inhibiting TTR expression in a cell, wherein the methodcomprises (a) contacting the cell with a dsRNA described in the Summary,above; and (b) maintaining the cell produced in step (a) for a timesufficient to obtain degradation of the mRNA transcript of a TTR gene,thereby inhibiting expression of the TTR gene in the cell.

The details of one or more embodiments of the invention are set forth inthe description below. Other features, objects, and advantages of theinvention will be apparent from the description and the drawings, andfrom the claims.

DESCRIPTION OF THE DRAWINGS

FIG. 1 is a graph of TNFalpha and IFNalpha levels in cultured humanPBMCs following transfection with TTR siRNAs.

FIGS. 2A and 2B are dose response curves for AD-18324 and AD-18328,respectively, in HepG2 cells.

FIG. 3 is a dose response curve for AD-18246 in HepG2 cells.

FIG. 4A and FIG. 4B show inhibition of liver mRNA and plasma proteinlevels, respectively, in transgenic H129-mTTR-KO/iNOS-KO/hTTR mice by anintravenous bolus administration of TTR-dsRNA (AD-18324, AD-18328 andAD-18246) formulated in LNP01.

FIG. 5 is a graph summarizing the measurements of TTR mRNA levels inlivers of non-human primates following 15-minute intravenous infusion ofTTR-dsRNA (AD-18324 and AD-18328) formulated in SNALP.

FIG. 6A and FIG. 6B show inhibition of human V30M TTR liver mRNA andserum protein levels, respectively, in transgenic mice by an intravenousbolus administration of SNALP-18328. Group means were determined,normalized to the PBS control group, and then plotted. Error barsrepresent standard deviations. The percentage reduction of the groupmean, relative to PBS, is indicated for the SNALP-1955 and SNALP-18328groups. (***p<0.001, One-way ANOVA, with Dunn's post-hoc test).

FIG. 7A and FIG. 7B show the durability of reduction of human V30M TTRliver mRNA and serum protein levels, respectively, in transgenic miceover 22 days following a single intravenous bolus administration ofSNALP-18328. Group means were determined. TTR/GAPDH mRNA levels werenormalized to day 0 levels and plotted. The percent reduction ofnormalized TTR mRNA levels relative to SNALP-1955 for each time pointwere calculated and are indicated for the SNALP-18328 groups.(***p<0.001, One-way ANOVA, with Dunn's post-hoc test).

FIG. 8 shows the timecourse of TTR serum protein levels in non-humanprimates over 14 days following a single 15-minute intravenous infusionof SNALP-18328.

FIG. 9 shows reduction of TTR-immunoreactivity in various tissues ofhuman V30M TTR/HSF-1 knock-out mice following intravenous bolusadministration of SNALP-18328. E, esophagus; S, stomach; I1,intestine/duodenum; I4, intestine/colon; N, nerve; D, dorsal rootganglia.

FIG. 10 shows the measurements of TTR mRNA levels in livers of non-humanprimates following 15-minute intravenous infusion of XTC-SNALP-18328.

FIGS. 11A and 11B show the measurements of TTR mRNA and serum proteinlevels, respectively, in livers of non-human primates following15-minute intravenous infusion of LNP09-18328 or LNP11-18328. FIG. 11Cshows the timecourse of TTR serum protein levels over 28 days followinga 15-minute intravenous infusion of 0.3 mg/kg LNP09-18328, as comparedto the PBS control group.

FIG. 12 shows the sequence of human TTR mRNA (Ref. Seq. NM_(—)000371.3,SEQ ID NO:1331).

FIGS. 13A and 13B are the sequences of human and rat TTR mRNA,respectively. FIG. 13A is the sequence of human TTR mRNA (Ref Seq.NM_(—)000371.2, SEQ ID NO:1329). FIG. 13B is the sequence of rat TTRmRNA (Ref. Seq. NM_(—)012681.1, SEQ ID NO:1330).

FIG. 14 shows the nucleotide alignment of NM_(—)000371.3 (SEQ ID NO:1331), NM_(—)000371.2 (SEQ ID NO: 1329), and AD-18328 (SEQ ID NO: 1410).

FIG. 15 illustrates symptoms and mutations in TTR associated withfamilial amyloidotic neuropathy, familial amyloidotic cardiomyopathy andCNS amyloidosis.

FIG. 16 shows reduction of TTR mRNA levels in the liver with SNALP-18534with different infusion durations. Groups of animals (n=4/group) wereadministered 1 mg/kg SNALP-18534 via a 15-minute, or 1, 2, or 3 hourinfusion. Forty-eight hours later, rats were euthanized and liversharvested. TTR and GAPDH mRNA levels were measured from liver lysatesusing the Quantigene bDNA assay. The ratio of TTR to GAPDH mRNA levelswas calculated for each animal. Group means were determined andnormalized to a PBS control group, and then plotted. Error barsrepresent standard deviations. (***p<0.001, One-way ANOVA withBonferroni post-hoc test, relative to PBS).

FIG. 17 shows the measurements of TTR mRNA levels in livers of ratsfollowing 15-minute intravenous infusion of LNP07-18534 or LNP08-18534.

FIG. 18 shows in vivo inhibition of endogenous TTR mRNA levels in liversof Sprague-Dawley Rats following a 15-min IV infusion of LNP09-18534 orLNP11-18534. Groups of animals (n=4/group) were intravenouslyadministered 0.01, 0.03, 0.1, or 0.3 mg/kg LNP09-18534, LNP-11-18534; orPBS via a 15-minute infusion. Forty-eight hours later, animals wereeuthanized and livers harvested. TTR and GAPDH mRNA levels were measuredfrom liver biopsy lysates using the Quantigene bDNA assay. The ratio ofTTR to GAPDH mRNA levels was calculated for each animal. Group meanswere determined, normalized to the PBS control group, and then plotted.Error bars represent standard deviations.

DETAILED DESCRIPTION OF THE INVENTION

The invention provides dsRNAs and methods of using the dsRNAs forinhibiting the expression of a TTR gene in a cell or a mammal where thedsRNA targets a TTR gene. The invention also provides compositions andmethods for treating pathological conditions and diseases, such as a TTRamyloidosis, in a mammal caused by the expression of a TTR gene. dsRNAdirects the sequence-specific degradation of mRNA through a processknown as RNA interference (RNAi).

The dsRNAs of the compositions featured herein include an RNA strand(the antisense strand) having a region which is less than 30 nucleotidesin length, generally 19-24 nucleotides in length, and is substantiallycomplementary to at least part of an mRNA transcript of a TTR gene. Theuse of these dsRNAs enables the targeted degradation of mRNAs of genesthat are implicated in pathologies associated with TTR expression inmammals. Very low dosages of TTR dsRNAs in particular can specificallyand efficiently mediate RNAi, resulting in significant inhibition ofexpression of a TTR gene. Using cell-based assays, the present inventorshave demonstrated that dsRNAs targeting TTR can specifically andefficiently mediate RNAi, resulting in significant inhibition ofexpression of a TTR gene. Thus, methods and compositions including thesedsRNAs are useful for treating pathological processes that can bemediated by down regulating TTR, such as in the treatment of a liverdisorder or a TTR amyloidosis, e.g., FAP.

The methods and compositions containing a TTR dsRNA are useful fortreating pathological processes mediated by TTR expression, such as aTTR amyloidosis. In an embodiment, a method of treating a disordermediated by TTR expression includes administering to a human in need ofsuch treatment a therapeutically effective amount of a dsRNA targeted toTTR. In an embodiment, a dsRNA is administered to the human at about0.01, 0.1, 0.5, 1.0, 2, 2.5, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14,15, 16, 17, 18, 19, 20, 21, 22, 23, 24, or 25 mg/kg.

The following detailed description discloses how to make and use thecompositions containing dsRNAs to inhibit the expression of a TTR gene,as well as compositions and methods for treating diseases and disorderscaused by the expression of this gene. The pharmaceutical compositionsfeatured in the invention include a dsRNA having an antisense strandcomprising a region of complementarity which is less than 30 nucleotidesin length, generally 19-24 nucleotides in length, and is substantiallycomplementary to at least part of an RNA transcript of a TTR gene,together with a pharmaceutically acceptable carrier. The compositionsfeatured in the invention also include a dsRNA having an antisensestrand having a region of complementarity which is less than 30nucleotides in length, generally 19-24 nucleotides in length, and issubstantially complementary to at least part of an RNA transcript of aTTR gene.

The sense strand of a dsRNA can include 15, 16, 17, 18, 19, 20, 21, ormore contiguous nucleotides of SEQ ID NO:169, SEQ ID NO:449, SEQ IDNO:729, or SEQ ID NO:1009. The antisense strand of a dsRNA can include15, 16, 17, 18, 19, 20, 21, or more contiguous nucleotides of SEQ IDNO:170, SEQ ID NO:450, SEQ ID NO:730, or SEQ ID NO:1010. In anembodiment, the sense strand of a dsRNA can consist of SEQ ID NO:449 orfragments thereof and the antisense strand can consist of SEQ ID NO:450or fragments thereof. In an embodiment, the sense strand of a dsRNA canconsist of SEQ ID NO:729 or fragments thereof and the antisense strandcan consist of SEQ ID NO:730 or fragments thereof. In an embodiment, thesense strand of a dsRNA can consist of SEQ ID NO:1009 or fragmentsthereof and the antisense strand can consist of SEQ ID NO:1010 orfragments thereof.

In an embodiment, a dsRNA can include at least 1, 2, 3, 4, 5, 6, 7, 8,9, 10, or more modified nucleotides. In an embodiment, a modifiednucleotide can include a 2′-O-methyl modified nucleotide, a nucleotidecomprising a 5′-phosphorothioate group, and/or a terminal nucleotidelinked to a cholesteryl derivative or dodecanoic acid bisdecylamidegroup. In an embodiment, a modified nucleotide can include a2′-deoxy-2′-fluoro modified nucleotide, a 2′-deoxy-modified nucleotide,a locked nucleotide, an abasic nucleotide, 2′-amino-modified nucleotide,2′-alkyl-modified nucleotide, morpholino nucleotide, a phosphoramidate,and/or a non-natural base comprising nucleotide.

In an embodiment, the region of complementary of a dsRNA is at least 10,11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, or more nucleotides inlength. In an embodiment, the region of complementary includes 10, 11,12, 13, 14, 15, 16, 17, 18, 19, 20, 21, or more contiguous nucleotidesof SEQ ID NO:169.

In an embodiment, each strand of a dsRNA is 15, 16, 17, 18, 19, 20, 21,22, 23, 24, 25, 26, 27, 28, 29, 30 or more nucleotides in length. In anembodiment, the dsRNA includes a sense strand, or 10, 11, 12, 13, 14,15, 16, 17, 18, 19, 20, or 21 nucleotide fragment thereof, selected fromTables 3A, 3B, 4, 6A, 6B, 7, and 16, and an antisense strand, or 10, 11,12, 13, 14, 15, 16, 17, 18, 19, 20, or 21 nucleotide fragment thereof,selected from Tables 3A, 3B, 4, 6A, 6B, 7, and 16.

In an embodiment, administration of a dsRNA to a cell results in about40%, 45%, 50%, 55%, 60%, 65%, 70%, 75%, 80%, 90%, 95% or more inhibitionof TTR mRNA expression as measured by a real time PCR assay. In anembodiment, administration of a dsRNA to a cell results in about 40% to45%, 45% to 50%, 50% to 55%, 55% to 60%, 60% to 65%, 65% to 70%, 70% to75%, 75% to 80%, 80% to 85%, 85% to 90%, 90% to 95% or more inhibitionof TTR mRNA expression as measured by a real time PCR assay. In anembodiment, administration of a dsRNA to a cell results in about 40%,45%, 50%, 55%, 60%, 65%, 70%, 75%, 80%, 90%, 95% or more inhibition ofTTR mRNA expression as measured by a branched DNA assay. In anembodiment, administration of a dsRNA to a cell results in about 40% to45%, 45% to 50%, 50% to 55%, 55% to 60%, 60% to 65%, 65% to 70%, 70% to75%, 75% to 80%, 80% to 85%, 85% to 90%, 90% to 95% or more inhibitionof TTR mRNA expression as measured by a branched DNA assay.

In an embodiment, a dsRNA has an IC50 of less than 0.01 pM, 0.1 pM, 1pM, 5 pM, 10 pM, 100 pM, or 1000 pM. In an embodiment, a dsRNA has anED50 of about 0.01, 0.1, 1, 5, or mg/kg.

In an embodiment, administration of a dsRNA can reduce TTR mRNA by about40%, 45%, 50%, 55%, 60%, 65%, 70%, 75%, 80%, 90%, 95% or more incynomolgus monkeys. In an embodiment, administration of a dsRNA reducesliver TTR mRNA levels by about 40%, 45%, 50%, 55%, 60%, 65%, 70%, 75%,80%, 90%, 95% or more or serum TTR protein levels by about 40%, 45%,50%, 55%, 60%, 65%, 70%, 75%, 80%, 90%, 95% or more. In an embodiment,administration of a dsRNA reduces liver TTR mRNA levels and/or serum TTRprotein levels up to 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15,16, 17, 18, 19, 20, 21, 22, 23, 24, 25, or more days.

In an embodiment, a dsRNA is formulated in a LNP formulation and reducesTTR mRNA levels by about 40%, 45%, 50%, 55%, 60%, 65%, 70%, 75%, 80%,90%, 95% or more at a dose of 0.1, 0.2, 0.3, 0.4, 0.5, 0.6, 0.7, 0.8,0.9, or 1 mg/kg, relative to a PBC control group. In an embodiment, adsRNA is formulated in a LNP formulation and reduces TTR protein levelsabout 40%, 45%, 50%, 55%, 60%, 65%, 70%, 75%, 80%, 90%, 95% or morerelative to a PBC control group as measured by a western blot. In anembodiment, a dsRNA suppresses serum TTR protein levels up to day 1, 2,3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22,23, 24, or 25 post-treatment when administered to a subject in needthereof at 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17,18, 19, 20, 21, 22, 23, 24, or 25 mg/kg.

Accordingly, in some aspects, pharmaceutical compositions containing aTTR dsRNA and a pharmaceutically acceptable carrier, methods of usingthe compositions to inhibit expression of a TTR gene, and methods ofusing the pharmaceutical compositions to treat diseases caused byexpression of a TTR gene are featured in the invention.

I. Definitions

For convenience, the meaning of certain terms and phrases used in thespecification, examples, and appended claims, are provided below. Ifthere is an apparent discrepancy between the usage of a term in otherparts of this specification and its definition provided in this section,the definition in this section shall prevail.

“G,” “C,” “A” and “U” each generally stand for a nucleotide thatcontains guanine, cytosine, adenine, and uracil as a base, respectively.“T” and “dT” are used interchangeably herein and refer to adeoxyribonucleotide wherein the nucleobase is thymine, e.g.,deoxyribothymine. However, it will be understood that the term“ribonucleotide” or “nucleotide” or “deoxyribonucleotide” can also referto a modified nucleotide, as further detailed below, or a surrogatereplacement moiety. The skilled person is well aware that guanine,cytosine, adenine, and uracil may be replaced by other moieties withoutsubstantially altering the base pairing properties of an oligonucleotidecomprising a nucleotide bearing such replacement moiety. For example,without limitation, a nucleotide comprising inosine as its base may basepair with nucleotides containing adenine, cytosine, or uracil. Hence,nucleotides containing uracil, guanine, or adenine may be replaced inthe nucleotide sequences of the invention by a nucleotide containing,for example, inosine. Sequences comprising such replacement moieties areembodiments of the invention.

As used herein, “transthyretin” (“TTR”) refers to a gene in a cell. TTRis also known as ATTR, HsT2651, PALB, prealbumin, TBPA, andtransthyretin (prealbumin, amyloidosis type I). The sequence of a humanTTR mRNA transcript can be found at NM_(—)000371. The sequence of mouseTTR mRNA can be found at NM_(—)013697.2, and the sequence of rat TTRmRNA can be found at NM_(—)012681.1.

As used herein, “target sequence” refers to a contiguous portion of thenucleotide sequence of an mRNA molecule formed during the transcriptionof a TTR gene, including mRNA that is a product of RNA processing of aprimary transcription product.

As used herein, the term “strand comprising a sequence” refers to anoligonucleotide comprising a chain of nucleotides that is described bythe sequence referred to using the standard nucleotide nomenclature.

As used herein, and unless otherwise indicated, the term“complementary,” when used to describe a first nucleotide sequence inrelation to a second nucleotide sequence, refers to the ability of anoligonucleotide or polynucleotide comprising the first nucleotidesequence to hybridize and form a duplex structure under certainconditions with an oligonucleotide or polynucleotide comprising thesecond nucleotide sequence, as will be understood by the skilled person.Such conditions can, for example, be stringent conditions, wherestringent conditions may include: 400 mM NaCl, 40 mM PIPES pH 6.4, 1 mMEDTA, 50° C. or 70° C. for 12-16 hours followed by washing. Otherconditions, such as physiologically relevant conditions as may beencountered inside an organism, can apply. The skilled person will beable to determine the set of conditions most appropriate for a test ofcomplementarity of two sequences in accordance with the ultimateapplication of the hybridized nucleotides.

This includes base-pairing of the oligonucleotide or polynucleotidecomprising the first nucleotide sequence to the oligonucleotide orpolynucleotide comprising the second nucleotide sequence over the entirelength of the first and second nucleotide sequence. Such sequences canbe referred to as “fully complementary” with respect to each otherherein. However, where a first sequence is referred to as “substantiallycomplementary” with respect to a second sequence herein, the twosequences can be fully complementary, or they may form one or more, butgenerally not more than 4, 3 or 2 mismatched base pairs uponhybridization, while retaining the ability to hybridize under theconditions most relevant to their ultimate application. However, wheretwo oligonucleotides are designed to form, upon hybridization, one ormore single stranded overhangs, such overhangs shall not be regarded asmismatches with regard to the determination of complementarity. Forexample, a dsRNA comprising one oligonucleotide 21 nucleotides in lengthand another oligonucleotide 23 nucleotides in length, wherein the longeroligonucleotide comprises a sequence of 21 nucleotides that is fullycomplementary to the shorter oligonucleotide, may yet be referred to as“fully complementary” for the purposes described herein.

“Complementary” sequences, as used herein, may also include, or beformed entirely from, non-Watson-Crick base pairs and/or base pairsformed from non-natural and modified nucleotides, in as far as the aboverequirements with respect to their ability to hybridize are fulfilled.Such non-Watson-Crick base pairs includes, but not limited to, G:UWobble or Hoogstein base pairing.

The terms “complementary,” “fully complementary” and “substantiallycomplementary” herein may be used with respect to the base matchingbetween the sense strand and the antisense strand of a dsRNA, or betweenthe antisense strand of a dsRNA and a target sequence, as will beunderstood from the context of their use.

As used herein, a polynucleotide that is “substantially complementary toat least part of” a messenger RNA (mRNA) refers to a polynucleotide thatis substantially complementary to a contiguous portion of the mRNA ofinterest (e.g., an mRNA encoding TTR) including a 5′ UTR, an openreading frame (ORF), or a 3′ UTR. For example, a polynucleotide iscomplementary to at least a part of a TTR mRNA if the sequence issubstantially complementary to a non-interrupted portion of an mRNAencoding TTR.

The term “double-stranded RNA” or “dsRNA,” as used herein, refers to acomplex of ribonucleic acid molecules, having a duplex structurecomprising two anti-parallel and substantially complementary, as definedabove, nucleic acid strands. In general, the majority of nucleotides ofeach strand are ribonucleotides, but as described in detail herein, eachor both strands can also include at least one non-ribonucleotide, e.g.,a deoxyribonucleotide and/or a modified nucleotide. In addition, as usedin this specification, “dsRNA” may include chemical modifications toribonucleotides, including substantial modifications at multiplenucleotides and including all types of modifications disclosed herein orknown in the art. Any such modifications, as used in an siRNA typemolecule, are encompassed by “dsRNA” for the purposes of thisspecification and claims.

The two strands forming the duplex structure may be different portionsof one larger RNA molecule, or they may be separate RNA molecules. Wherethe two strands are part of one larger molecule, and therefore areconnected by an uninterrupted chain of nucleotides between the 3′-end ofone strand and the 5′-end of the respective other strand forming theduplex structure, the connecting RNA chain is referred to as a “hairpinloop.” Where the two strands are connected covalently by means otherthan an uninterrupted chain of nucleotides between the 3′-end of onestrand and the 5′-end of the respective other strand forming the duplexstructure, the connecting structure is referred to as a “linker.” TheRNA strands may have the same or a different number of nucleotides. Themaximum number of base pairs is the number of nucleotides in theshortest strand of the dsRNA minus any overhangs that are present in theduplex. In addition to the duplex structure, a dsRNA may comprise one ormore nucleotide overhangs. The term “siRNA” is also used herein to referto a dsRNA as described above.

As used herein, a “nucleotide overhang” refers to the unpairednucleotide or nucleotides that protrude from the duplex structure of adsRNA when a 3′-end of one strand of the dsRNA extends beyond the 5′-endof the other strand, or vice versa. “Blunt” or “blunt end” means thatthere are no unpaired nucleotides at that end of the dsRNA, i.e., nonucleotide overhang. A “blunt ended” dsRNA is a dsRNA that isdouble-stranded over its entire length, i.e., no nucleotide overhang ateither end of the molecule.

The term “antisense strand” refers to the strand of a dsRNA whichincludes a region that is substantially complementary to a targetsequence. As used herein, the term “region of complementarity” refers tothe region on the antisense strand that is substantially complementaryto a sequence, for example a target sequence, as defined herein. Wherethe region of complementarity is not fully complementary to the targetsequence, the mismatches are most tolerated in the terminal regions and,if present, are generally in a terminal region or regions, e.g., within6, 5, 4, 3, or 2 nucleotides of the 5′ and/or 3′ terminus.

The term “sense strand,” as used herein, refers to the strand of a dsRNAthat includes a region that is substantially complementary to a regionof the antisense strand.

As used herein, the term “SNALP” refers to a stable nucleic acid-lipidparticle. A SNALP represents a vesicle of lipids coating a reducedaqueous interior comprising a nucleic acid such as a dsRNA or a plasmidfrom which a dsRNA is transcribed. SNALP are described, e.g., in U.S.Patent Application Publication Nos. 20060240093, 20070135372, and U.S.Ser. No. 61/045,228 filed on Apr. 15, 2008. These applications arehereby incorporated by reference.

“Introducing into a cell,” when referring to a dsRNA, means facilitatinguptake or absorption into the cell, as is understood by those skilled inthe art. Absorption or uptake of dsRNA can occur through unaideddiffusive or active cellular processes, or by auxiliary agents ordevices. The meaning of this term is not limited to cells in vitro; adsRNA may also be “introduced into a cell,” wherein the cell is part ofa living organism. In such instance, introduction into the cell willinclude the delivery to the organism. For example, for in vivo delivery,dsRNA can be injected into a tissue site or administered systemically.In vitro introduction into a cell includes methods known in the art suchas electroporation and lipofection. Further approaches are describedherein or known in the art.

The terms “silence,” “inhibit the expression of,” “down-regulate theexpression of,” “suppress the expression of” and the like in as far asthey refer to a TTR gene, herein refer to the at least partialsuppression of the expression of a TTR gene, as manifested by areduction of the amount of mRNA which may be isolated from a first cellor group of cells in which a TTR gene is transcribed and which has orhave been treated such that the expression of a TTR gene is inhibited,as compared to a second cell or group of cells substantially identicalto the first cell or group of cells but which has or have not been sotreated (control cells). The degree of inhibition is usually expressedin terms of

${\frac{{\left( {{mRNA}\mspace{14mu}{in}\mspace{14mu}{control}{\mspace{11mu}\;}{cells}} \right) - \left( {{mRNA}\mspace{14mu}{in}\mspace{14mu}{treated}\mspace{14mu}{cells}} \right)}\;}{\left( {{mRNA}\mspace{14mu}{in}\mspace{14mu}{control}{\mspace{11mu}\;}{cells}} \right)} \cdot 100}\%$

Alternatively, the degree of inhibition may be given in terms of areduction of a parameter that is functionally linked to TTR geneexpression, e.g., the amount of protein encoded by a TTR gene which issecreted by a cell, or the number of cells displaying a certainphenotype, e.g., apoptosis. In principle, TTR gene silencing may bedetermined in any cell expressing the target, either constitutively orby genomic engineering, and by any appropriate assay. However, when areference is needed in order to determine whether a given dsRNA inhibitsthe expression of a TTR gene by a certain degree and therefore isencompassed by the instant invention, the assays provided in theExamples below shall serve as such reference.

For example, in certain instances, expression of a TTR gene issuppressed by at least about 5%, 10%, 15%, 20%, 25%, 30%, 35%, 40%, 45%,or 50% by administration of the double-stranded oligonucleotide featuredin the invention. In some embodiments, a TTR gene is suppressed by atleast about 60%, 70%, or 80% by administration of the double-strandedoligonucleotide featured in the invention. In some embodiments, a TTRgene is suppressed by at least about 85%, 90%, or 95% by administrationof the double-stranded oligonucleotide featured in the invention.

As used herein in the context of TTR expression, the terms “treat,”“treatment,” and the like, refer to relief from or alleviation ofpathological processes mediated by TTR expression. In the context of thepresent invention insofar as it relates to any of the other conditionsrecited herein below (other than pathological processes mediated by TTRexpression), the terms “treat,” “treatment,” and the like mean torelieve or alleviate at least one symptom associated with suchcondition, or to slow or reverse the progression of such condition, suchas the slowing the progression of a TTR amyloidosis, such as FAP.Symptoms of TTR amyloidosis include sensory neuropathy (e.g.paresthesia, hypesthesia in distal limbs), autonomic neuropathy (e.g.,gastrointestinal dysfunction, such as gastric ulcer, or orthostatichypotension), motor neuropathy, seizures, dementia, myelopathy,polyneuropathy, carpal tunnel syndrome, autonomic insufficiency,cardiomyopathy, vitreous opacities, renal insufficiency, nephropathy,substantially reduced mBMI (modified Body Mass Index), cranial nervedysfunction, and corneal lattice dystrophy.

As used herein, the phrases “therapeutically effective amount” and“prophylactically effective amount” refer to an amount that provides atherapeutic benefit in the treatment, prevention, or management ofpathological processes mediated by TTR expression or an overt symptom ofpathological processes mediated by TTR expression. The specific amountthat is therapeutically effective can be readily determined by anordinary medical practitioner, and may vary depending on factors knownin the art, such as, for example, the type of pathological processesmediated by TTR expression, the patient's history and age, the stage ofpathological processes mediated by TTR expression, and theadministration of other anti-pathological processes mediated by TTRexpression agents.

As used herein, a “pharmaceutical composition” comprises apharmacologically effective amount of a dsRNA and a pharmaceuticallyacceptable carrier. As used herein, “pharmacologically effectiveamount,” “therapeutically effective amount” or simply “effective amount”refers to that amount of an RNA effective to produce the intendedpharmacological, therapeutic or preventive result. For example, if agiven clinical treatment is considered effective when there is at leasta 25% reduction in a measurable parameter associated with a disease ordisorder, a therapeutically effective amount of a drug for the treatmentof that disease or disorder is the amount necessary to effect at least a25% reduction in that parameter. For example, a therapeuticallyeffective amount of a dsRNA targeting TTR can reduce TTR serum levels byat least 25%. In another example, a therapeutically effective amount ofa dsRNA targeting TTR can improve liver function or renal function by atleast 25%.

The term “pharmaceutically acceptable carrier” refers to a carrier foradministration of a therapeutic agent. Such carriers include, but arenot limited to, saline, buffered saline, dextrose, water, glycerol,ethanol, and combinations thereof. The term specifically excludes cellculture medium. For drugs administered orally, pharmaceuticallyacceptable carriers include, but are not limited to pharmaceuticallyacceptable excipients such as inert diluents, disintegrating agents,binding agents, lubricating agents, sweetening agents, flavoring agents,coloring agents and preservatives. Suitable inert diluents includesodium and calcium carbonate, sodium and calcium phosphate, and lactose,while corn starch and alginic acid are suitable disintegrating agents.Binding agents may include starch and gelatin, while the lubricatingagent, if present, will generally be magnesium stearate, stearic acid ortalc. If desired, the tablets may be coated with a material such asglyceryl monostearate or glyceryl distearate, to delay absorption in thegastrointestinal tract.

As used herein, a “transformed cell” is a cell into which a vector hasbeen introduced from which a dsRNA molecule may be expressed.

II. Double-Stranded Ribonucleic Acid (dsRNA)

As described in more detail herein, the invention providesdouble-stranded ribonucleic acid (dsRNA) molecules for inhibiting theexpression of a TTR gene in a cell or mammal, e.g., in a human having aTTR amyloidosis, where the dsRNA includes an antisense strand having aregion of complementarity which is complementary to at least a part ofan mRNA formed in the expression of a TTR gene, and where the region ofcomplementarity is less than 30 nucleotides in length, generally 19-24nucleotides in length, and where said dsRNA, upon contact with a cellexpressing said TTR gene, inhibits the expression of said TTR gene by atleast 30% as assayed by, for example, a PCR or branched DNA (bDNA)-basedmethod, or by a protein-based method, such as by Western blot.Expression of a TTR gene can be reduced by at least 30% when measured byan assay as described in the Examples below. For example, expression ofa TTR gene in cell culture, such as in Hep3B cells, can be assayed bymeasuring TTR mRNA levels, such as by bDNA or TaqMan assay, or bymeasuring protein levels, such as by ELISA assay. The dsRNA of theinvention can further include one or more single-stranded nucleotideoverhangs.

The dsRNA can be synthesized by standard methods known in the art asfurther discussed below, e.g., by use of an automated DNA synthesizer,such as are commercially available from, for example, Biosearch, AppliedBiosystems, Inc. The dsRNA includes two RNA strands that aresufficiently complementary to hybridize to form a duplex structure. Onestrand of the dsRNA (the antisense strand) includes a region ofcomplementarity that is substantially complementary, and generally fullycomplementary, to a target sequence, derived from the sequence of anmRNA formed during the expression of a TTR gene, the other strand (thesense strand) includes a region that is complementary to the antisensestrand, such that the two strands hybridize and form a duplex structurewhen combined under suitable conditions. Generally, the duplex structureis between 15 and 30 or between 25 and 30, or between 18 and 25, orbetween 19 and 24, or between 19 and 21, or 19, 20, or 21 base pairs inlength. In one embodiment the duplex is 19 base pairs in length. Inanother embodiment the duplex is 21 base pairs in length. When twodifferent siRNAs are used in combination, the duplex lengths can beidentical or can differ.

Each strand of the dsRNA of invention is generally between 15 and 30, orbetween 18 and 25, or 18, 19, 20, 21, 22, 23, 24, or 25 nucleotides inlength. In other embodiments, each is strand is 25-30 nucleotides inlength. Each strand of the duplex can be the same length or of differentlengths. When two different siRNAs are used in combination, the lengthsof each strand of each siRNA can be identical or can differ.

The dsRNA of the invention can include one or more single-strandedoverhang(s) of one or more nucleotides. In one embodiment, at least oneend of the dsRNA has a single-stranded nucleotide overhang of 1 to 4,generally 1 or 2 nucleotides. In another embodiment, the antisensestrand of the dsRNA has 1-10 nucleotides overhangs each at the 3′ endand the 5′ end over the sense strand. In further embodiments, the sensestrand of the dsRNA has 1-10 nucleotides overhangs each at the 3′ endand the 5′ end over the antisense strand.

A dsRNAs having at least one nucleotide overhang can have unexpectedlysuperior inhibitory properties than the blunt-ended counterpart. In someembodiments the presence of only one nucleotide overhang strengthens theinterference activity of the dsRNA, without affecting its overallstability. A dsRNA having only one overhang has proven particularlystable and effective in vivo, as well as in a variety of cells, cellculture mediums, blood, and serum. Generally, the single-strandedoverhang is located at the 3′-terminal end of the antisense strand or,alternatively, at the 3′-terminal end of the sense strand. The dsRNA canalso have a blunt end, generally located at the 5′-end of the antisensestrand. Such dsRNAs can have improved stability and inhibitory activity,thus allowing administration at low dosages, i.e., less than 5 mg/kgbody weight of the recipient per day. Generally, the antisense strand ofthe dsRNA has a nucleotide overhang at the 3′-end, and the 5′-end isblunt. In another embodiment, one or more of the nucleotides in theoverhang is replaced with a nucleoside thiophosphate.

In one embodiment, a TTR gene is a human TTR gene. In specificembodiments, the sense strand of the dsRNA is one of the sense sequencesfrom Tables 3A, 3B, 4, 6A, 6B, or 7, and the antisense strand is one ofthe antisense sequences of Tables 3A, 3B, 4, 6A, 6B, or 7. Alternativeantisense agents that target elsewhere in the target sequence providedin Tables 3A, 3B, 4, 6A, 6B, or 7 can readily be determined using thetarget sequence and the flanking TTR sequence.

The skilled person is well aware that dsRNAs having a duplex structureof between 20 and 23, but specifically 21, base pairs have been hailedas particularly effective in inducing RNA interference (Elbashir et al.,EMBO 2001, 20:6877-6888). However, others have found that shorter orlonger dsRNAs can be effective as well. In the embodiments describedabove, by virtue of the nature of the oligonucleotide sequences providedin Tables 3A, 3B, 4, 6A, 6B, and 7, the dsRNAs featured in the inventioncan include at least one strand of a length described herein. It can bereasonably expected that shorter dsRNAs having one of the sequences ofTables 3A, 3B, 4, 6A, 6B, or 7 minus only a few nucleotides on one orboth ends may be similarly effective as compared to the dsRNAs describedabove. Hence, dsRNAs having a partial sequence of at least 15, 16, 17,18, 19, 20, or more contiguous nucleotides from one of the sequences ofTables 3, 4, 6 or 7, and differing in their ability to inhibit theexpression of a TTR gene in an assay as described herein below by notmore than 5, 10, 15, 20, 25, or 30% inhibition from a dsRNA comprisingthe full sequence, are contemplated by the invention. Further, dsRNAsthat cleave within a desired TTR target sequence can readily be madeusing the corresponding TTR antisense sequence and a complementary sensesequence.

In addition, the dsRNAs provided in Tables 3A, 3B, 4, 6A, 6B, or 7identify a site in a TTR that is susceptible to RNAi based cleavage. Assuch, the present invention further features dsRNAs that target withinthe sequence targeted by one of the agents of the present invention. Asused herein, a second dsRNA is said to target within the sequence of afirst dsRNA if the second dsRNA cleaves the message anywhere within themRNA that is complementary to the antisense strand of the first dsRNA.Such a second dsRNA will generally consist of at least 15 contiguousnucleotides from one of the sequences provided in Tables 3A, 3B, 4, 6A,6B, or 7 coupled to additional nucleotide sequences taken from theregion contiguous to the selected sequence in a TTR gene.

The dsRNA featured in the invention can contain one or more mismatchesto the target sequence. In one embodiment, the dsRNA featured in theinvention contains no more than 3 mismatches. If the antisense strand ofthe dsRNA contains mismatches to a target sequence, it is preferablethat the area of mismatch not be located in the center of the region ofcomplementarity. If the antisense strand of the dsRNA containsmismatches to the target sequence, it is preferable that the mismatch berestricted to 5 nucleotides from either end, for example 5, 4, 3, 2, or1 nucleotide from either the 5′ or 3′ end of the region ofcomplementarity. For example, for a 23 nucleotide dsRNA strand which iscomplementary to a region of a TTR gene, the dsRNA generally does notcontain any mismatch within the central 13 nucleotides. The methodsdescribed within the invention can be used to determine whether a dsRNAcontaining a mismatch to a target sequence is effective in inhibitingthe expression of a TTR gene. Consideration of the efficacy of dsRNAswith mismatches in inhibiting expression of a TTR gene is important,especially if the particular region of complementarity in a TTR gene isknown to have polymorphic sequence variation within the population.

Modifications

In yet another embodiment, the dsRNA is chemically modified to enhancestability. The nucleic acids featured in the invention may besynthesized and/or modified by methods well established in the art, suchas those described in “Current protocols in nucleic acid chemistry,”Beaucage, S. L. et al. (Eds.), John Wiley & Sons, Inc., New York, N.Y.,USA, which is hereby incorporated herein by reference. Specific examplesof dsRNA compounds useful in this invention include dsRNAs containingmodified backbones or no natural internucleoside linkages. As defined inthis specification, dsRNAs having modified backbones include those thatretain a phosphorus atom in the backbone and those that do not have aphosphorus atom in the backbone. For the purposes of this specification,and as sometimes referenced in the art, modified dsRNAs that do not havea phosphorus atom in their internucleoside backbone can also beconsidered to be oligonucleosides.

Modified dsRNA backbones include, for example, phosphorothioates, chiralphosphorothioates, phosphorodithioates, phosphotriesters,aminoalkylphosphotriesters, methyl and other alkyl phosphonatesincluding 3′-alkylene phosphonates and chiral phosphonates,phosphinates, phosphoramidates including 3′-amino phosphoramidate andaminoalkylphosphoramidates, thionophosphoramidates,thionoalkylphosphonates, thionoalkylphosphotriesters, andboranophosphates having normal 3′-5′ linkages, 2′-5′ linked analogs ofthese, and those) having inverted polarity wherein the adjacent pairs ofnucleoside units are linked 3′-5′ to 5′-3′ or 2′-5′ to 5′-2′. Varioussalts, mixed salts and free acid forms are also included.

Representative U.S. patents that teach the preparation of the abovephosphorus-containing linkages include, but are not limited to, U.S.Pat. Nos. 3,687,808; 4,469,863; 4,476,301; 5,023,243; 5,177,195;5,188,897; 5,264,423; 5,276,019; 5,278,302; 5,286,717; 5,321,131;5,399,676; 5,405,939; 5,453,496; 5,455,233; 5,466,677; 5,476,925;5,519,126; 5,536,821; 5,541,316; 5,550,111; 5,563,253; 5,571,799;5,587,361; and 5,625,050, each of which is herein incorporated byreference

Modified dsRNA backbones that do not include a phosphorus atom thereinhave backbones that are formed by short chain alkyl or cycloalkylinternucleoside linkages, mixed heteroatoms and alkyl or cycloalkylinternucleoside linkages, or ore or more short chain heteroatomic orheterocyclic internucleoside linkages. These include those havingmorpholino linkages (formed in part from the sugar portion of anucleoside); siloxane backbones; sulfide, sulfoxide and sulfonebackbones; formacetyl and thioformacetyl backbones; methylene formacetyland thioformacetyl backbones; alkene containing backbones; sulfamatebackbones; methyleneimino and methylenehydrazino backbones; sulfonateand sulfonamide backbones; amide backbones; and others having mixed N,O, S and CH₂ component parts.

Representative U.S. patents that teach the preparation of the aboveoligonucleosides include, but are not limited to, U.S. Pat. Nos.5,034,506; 5,166,315; 5,185,444; 5,214,134; 5,216,141; 5,235,033;5,64,562; 5,264,564; 5,405,938; 5,434,257; 5,466,677; 5,470,967;5,489,677; 5,541,307; 5,561,225; 5,596,086; 5,602,240; 5,608,046;5,610,289; 5,618,704; 5,623,070; 5,663,312; 5,633,360; 5,677,437; and,5,677,439, each of which is herein incorporated by reference.

In other suitable dsRNA mimetics, both the sugar and the internucleosidelinkage, i.e., the backbone, of the nucleotide units are replaced withnovel groups. The base units are maintained for hybridization with anappropriate nucleic acid target compound. One such oligomeric compound,a dsRNA mimetic that has been shown to have excellent hybridizationproperties, is referred to as a peptide nucleic acid (PNA). In PNAcompounds, the sugar backbone of a dsRNA is replaced with an amidecontaining backbone, in particular an aminoethylglycine backbone. Thenucleobases are retained and are bound directly or indirectly to azanitrogen atoms of the amide portion of the backbone. Representative U.S.patents that teach the preparation of PNA compounds include, but are notlimited to, U.S. Pat. Nos. 5,539,082; 5,714,331; and 5,719,262, each ofwhich is herein incorporated by reference. Further teaching of PNAcompounds can be found in Nielsen et al., Science, 1991, 254, 1497-1500.

Other embodiments of the invention are dsRNAs with phosphorothioatebackbones and oligonucleosides with heteroatom backbones, and inparticular —CH₂—NH—CH₂—, —CH₂—N(CH₃)—O—CH₂— [known as a methylene(methylimino) or MMI backbone], —CH₂—O—N(CH₃)—CH₂—,—CH₂—N(CH₃)—N(CH₃)—CH₂— and —N(CH₃)—CH₂—CH₂— [wherein the nativephosphodiester backbone is represented as —O—P—O—CH₂—] of theabove-referenced U.S. Pat. No. 5,489,677, and the amide backbones of theabove-referenced U.S. Pat. No. 5,602,240. Also preferred are dsRNAshaving morpholino backbone structures of the above-referenced U.S. Pat.No. 5,034,506.

Modified dsRNAs may also contain one or more substituted sugar moieties.Preferred dsRNAs comprise one of the following at the 2′ position: OH;F; O-, S-, or N-alkyl; O-, S-, or N-alkenyl; O-, S- or N-alkynyl; orO-alkyl-O-alkyl, wherein the alkyl, alkenyl and alkynyl may besubstituted or unsubstituted C₁ to C₁₀ alkyl or C₂ to C₁₀ alkenyl andalkynyl. Particularly preferred are O[(CH₂)_(n)O]_(m)CH₃,O(CH₂)_(n)OCH₃, O(CH₂)_(n)NH₂, O(CH₂)_(n)CH₃, O(CH₂)_(n)ONH₂, andO(CH₂)_(n)ON[(CH₂)_(n)CH₃)]₂, where n and m are from 1 to about 10.Other preferred dsRNAs comprise one of the following at the 2′ position:C₁ to C₁₀ lower alkyl, substituted lower alkyl, alkaryl, aralkyl,O-alkaryl or O-aralkyl, SH, SCH₃, OCN, Cl, Br, CN, CF₃, OCF₃, SOCH₃,SO₂CH₃, ONO₂, NO₂, N₃, NH₂, heterocycloalkyl, heterocycloalkaryl,aminoalkylamino, polyalkylamino, substituted silyl, an RNA cleavinggroup, a reporter group, an intercalator, a group for improving thepharmacokinetic properties of an dsRNA, or a group for improving thepharmacodynamic properties of an dsRNA, and other substituents havingsimilar properties. A preferred modification includes 2′-methoxyethoxy(2′-O—CH₂CH₂OCH₃, also known as 2′-O-(2-methoxyethyl) or 2′-MOE) (Martinet al., Helv. Chim. Acta, 1995, 78, 486-504) i.e., an alkoxy-alkoxygroup. A further preferred modification includes2′-dimethylaminooxyethoxy, i.e., a O(CH₂)₂ON(CH₃)₂ group, also known as2′-DMAOE, as described in examples herein below, and2′-dimethylaminoethoxyethoxy (also known in the art as2′-O-dimethylaminoethoxyethyl or 2′-DMAEOE), i.e.,2′-O—CH₂—O—CH₂—N(CH₂)₂, also described in examples herein below.

Other preferred modifications include 2′-methoxy (2′-OCH₃),2′-aminopropoxy (2′-OCH₂CH₂CH₂NH₂) and 2′-fluoro (2′-F). Similarmodifications may also be made at other positions on the dsRNA,particularly the 3′ position of the sugar on the 3′ terminal nucleotideor in 2′-5′ linked dsRNAs and the 5′ position of 5′ terminal nucleotide.DsRNAs may also have sugar mimetics such as cyclobutyl moieties in placeof the pentofuranosyl sugar. Representative U.S. patents that teach thepreparation of such modified sugar structures include, but are notlimited to, U.S. Pat. Nos. 4,981,957; 5,118,800; 5,319,080; 5,359,044;5,393,878; 5,446,137; 5,466,786; 5,514,785; 5,519,134; 5,567,811;5,576,427; 5,591,722; 5,597,909; 5,610,300; 5,627,053; 5,639,873;5,646,265; 5,658,873; 5,670,633; and 5,700,920, certain of which arecommonly owned with the instant application, and each of which is hereinincorporated by reference in its entirety.

dsRNAs may also include nucleobase (often referred to in the art simplyas “base”) modifications or substitutions. As used herein, “unmodified”or “natural” nucleobases include the purine bases adenine (A) andguanine (G), and the pyrimidine bases thymine (T), cytosine (C) anduracil (U). Modified nucleobases include other synthetic and naturalnucleobases such as 5-methylcytosine (5-me-C), 5-hydroxymethyl cytosine,xanthine, hypoxanthine, 2-aminoadenine, 6-methyl and other alkylderivatives of adenine and guanine, 2-propyl and other alkyl derivativesof adenine and guanine, 2-thiouracil, 2-thiothymine and 2-thiocytosine,5-halouracil and cytosine, 5-propynyl uracil and cytosine, 6-azo uracil,cytosine and thymine, 5-uracil (pseudouracil), 4-thiouracil, 8-halo,8-amino, 8-thiol, 8-thioalkyl, 8-hydroxyl anal other 8-substitutedadenines and guanines, 5-halo, particularly 5-bromo, 5-trifluoromethyland other 5-substituted uracils and cytosines, 7-methylguanine and7-methyladenine, 8-azaguanine and 8-azaadenine, 7-deazaguanine and7-daazaadenine and 3-deazaguanine and 3-deazaadenine. Furthernucleobases include those disclosed in U.S. Pat. No. 3,687,808, thosedisclosed in The Concise Encyclopedia Of Polymer Science AndEngineering, pages 858-859, Kroschwitz, J. L, ed. John Wiley & Sons,1990, these disclosed by Englisch et al., Angewandte Chemie,International Edition, 1991, 30, 613, and those disclosed by Sanghvi, YS., Chapter 15, DsRNA Research and Applications, pages 289-302, Crooke,S. T. and Lebleu, B., Ed., CRC Press, 1993. Certain of these nucleobasesare particularly useful for increasing the binding affinity of theoligomeric compounds featured in the invention. These include5-substituted pyrimidines, 6-azapyrimidines and N-2, N-6 and 0-6substituted purines, including 2-aminopropyladenine, 5-propynyluraciland 5-propynylcytosine. 5-methylcytosine substitutions have been shownto increase nucleic acid duplex stability by 0.6-1.2° C. (Sanghvi, Y.S., Crooke, S. T. and Lebleu, B., Eds., DsRNA Research and Applications,CRC Press, Boca Raton, 1993, pp. 276-278) and are exemplary basesubstitutions, even more particularly when combined with2′-O-methoxyethyl sugar modifications.

Representative U.S. patents that teach the preparation of certain of theabove noted modified nucleobases as well as other modified nucleobasesinclude, but are not limited to, the above noted U.S. Pat. No.3,687,808, as well as U.S. Pat. Nos. 4,845,205; 5,130,30; 5,134,066;5,175,273; 5,367,066; 5,432,272; 5,457,187; 5,459,255; 5,484,908;5,502,177; 5,525,711; 5,552,540; 5,587,469; 5,594,121, 5,596,091;5,614,617; and 5,681,941, each of which is herein incorporated byreference, and U.S. Pat. No. 5,750,692, also herein incorporated byreference.

Conjugates

Another modification of the dsRNAs of the invention involves chemicallylinking to the dsRNA one or more moieties or conjugates which enhancethe activity, cellular distribution or cellular uptake of the dsRNA.Such moieties include but are not limited to lipid moieties such as acholesterol moiety (Letsinger et al., Proc. Natl. Acid. Sci. USA, 1989,86: 6553-6556), cholic acid (Manoharan et al., Biorg. Med. Chem. Let.,1994, 4:1053-1060), a thioether, e.g., beryl-S-tritylthiol (Manoharan etal., Ann. N.Y. Acad. Sci., 1992, 660:306-309; Manoharan et al., Biorg.Med. Chem. Let., 1993, 3:2765-2770), a thiocholesterol (Oberhauser etal., Nucl. Acids Res., 1992, 20:533-538), an aliphatic chain, e.g.,dodecandiol or undecyl residues (Saison-Behmoaras et al., EMBO J, 1991,10:1111-1118; Kabanov et al., FEBS Lett., 1990, 259:327-330; Svinarchuket al., Biochimie, 1993, 75:49-54), a phospholipid, e.g.,di-hexadecyl-rac-glycerol or triethyl-ammonium1,2-di-O-hexadecyl-rac-glycero-3-Hphosphonate (Manoharan et al.,Tetrahedron Lett., 1995, 36:3651-3654; Shea et al., Nucl. Acids Res.,1990, 18:3777-3783), a polyamine or a polyethylene glycol chain(Manoharan et al., Nucleosides & Nucleotides, 1995, 14:969-973), oradamantane acetic acid (Manoharan et al., Tetrahedron Lett., 1995,36:3651-3654), a palmityl moiety (Mishra et al., Biochim. Biophys. Acta,1995, 1264:229-237), or an octadecylamine orhexylamino-carbonyloxycholesterol moiety (Crooke et al., J. Pharmacol.Exp. Ther., 1996, 277:923-937).

Representative U.S. patents that teach the preparation of such dsRNAconjugates include, but are not limited to, U.S. Pat. Nos. 4,828,979;4,948,882; 5,218,105; 5,525,465; 5,541,313; 5,545,730; 5,552,538;5,578,717, 5,580,731; 5,591,584; 5,109,124; 5,118,802; 5,138,045;5,414,077; 5,486,603; 5,512,439; 5,578,718; 5,608,046; 4,587,044;4,605,735; 4,667,025; 4,762,779; 4,789,737; 4,824,941; 4,835,263;4,876,335; 4,904,582; 4,958,013; 5,082,830; 5,112,963; 5,214,136;5,082,830; 5,112,963; 5,214,136; 5,245,022; 5,254,469; 5,258,506;5,262,536; 5,272,250; 5,292,873; 5,317,098; 5,371,241, 5,391,723;5,416,203, 5,451,463; 5,510,475; 5,512,667; 5,514,785; 5,565,552;5,567,810; 5,574,142; 5,585,481; 5,587,371; 5,595,726; 5,597,696;5,599,923; 5,599,928 and 5,688,941, each of which is herein incorporatedby reference.

It is not necessary for all positions in a given compound to beuniformly modified, and in fact more than one of the aforementionedmodifications may be incorporated in a single compound or even at asingle nucleoside within a dsRNA. The present invention also includesdsRNA compounds which are chimeric compounds. “Chimeric” dsRNA compoundsor “chimeras,” in the context of this invention, are dsRNA compounds,particularly dsRNAs, which contain two or more chemically distinctregions, each made up of at least one monomer unit, i.e., a nucleotidein the case of a dsRNA compound. These dsRNAs typically contain at leastone region wherein the dsRNA is modified so as to confer upon the dsRNAincreased resistance to nuclease degradation, increased cellular uptake,and/or increased binding affinity for the target nucleic acid. Anadditional region of the dsRNA may serve as a substrate for enzymescapable of cleaving RNA:DNA or RNA:RNA hybrids. By way of example, RNaseH is a cellular endonuclease which cleaves the RNA strand of an RNA:DNAduplex. Activation of RNase H, therefore, results in cleavage of the RNAtarget, thereby greatly enhancing the efficiency of dsRNA inhibition ofgene expression. Consequently, comparable results can often be obtainedwith shorter dsRNAs when chimeric dsRNAs are used, compared tophosphorothioate deoxydsRNAs hybridizing to the same target region.

Cleavage of the RNA target can be routinely detected by gelelectrophoresis and, if necessary, associated nucleic acid hybridizationtechniques known in the art. The cleavage site on the target mRNA of adsRNA can be determined using methods generally known to one of ordinaryskill in the art, e.g., the 5′-RACE method described in Soutschek etal., Nature; 2004, Vol. 432, pp. 173-178 (which is herein incorporatedby reference for all purposes). In an embodiment, using the 5′-RACEmethod described by Soutschek et al., ALN-18328 was determined to cleavea TTR mRNA between the guanine nucleotide at position 636 of SEQ IDNO:1331 (NM_(—)000371.3) and the adenine nucleotide at position 637 ofSEQ ID NO:1331. In an embodiment, it was determined that ALN-18328 doesnot cleave a TTR mRNA between the adenine nucleotide at position 637 ofSEQ ID NO:1331 and the guanine nucleotide at position 638 of SEQ IDNO:1331.

In certain instances, the dsRNA may be modified by a non-ligand group. Anumber of non-ligand molecules have been conjugated to dsRNAs in orderto enhance the activity, cellular distribution or cellular uptake of thedsRNA, and procedures for performing such conjugations are available inthe scientific literature. Such non-ligand moieties have included lipidmoieties, such as cholesterol (Letsinger et al., Proc. Natl. Acad. Sci.USA, 1989, 86:6553), cholic acid (Manoharan et al., Bioorg. Med. Chem.Lett., 1994, 4:1053), a thioether, e.g., hexyl-5-tritylthiol (Manoharanet al., Ann. N.Y. Acad. Sci., 1992, 660:306; Manoharan et al., Bioorg.Med. Chem. Let., 1993, 3:2765), a thiocholesterol (Oberhauser et al.,Nucl. Acids Res., 1992, 20:533), an aliphatic chain, e.g., dodecandiolor undecyl residues (Saison-Behmoaras et al., EMBO J., 1991, 10:111;Kabanov et al., FEBS Lett., 1990, 259:327; Svinarchuk et al., Biochimie,1993, 75:49), a phospholipid, e.g., di-hexadecyl-rac-glycerol ortriethylammonium 1,2-di-O-hexadecyl-rac-glycero-3-H-phosphonate(Manoharan et al., Tetrahedron Lett., 1995, 36:3651; Shea et al., Nucl.Acids Res., 1990, 18:3777), a polyamine or a polyethylene glycol chain(Manoharan et al., Nucleosides & Nucleotides, 1995, 14:969), oradamantane acetic acid (Manoharan et al., Tetrahedron Lett., 1995,36:3651), a palmityl moiety (Mishra et al., Biochim. Biophys. Acta,1995, 1264:229), or an octadecylamine orhexylamino-carbonyl-oxycholesterol moiety (Crooke et al., J. Pharmacol.Exp. Ther., 1996, 277:923). Representative United States patents thatteach the preparation of such dsRNA conjugates have been listed above.Typical conjugation protocols involve the synthesis of dsRNAs bearing anamino linker at one or more positions of the sequence. The amino groupis then reacted with the molecule being conjugated using appropriatecoupling or activating reagents. The conjugation reaction may beperformed either with the dsRNA still bound to the solid support orfollowing cleavage of the dsRNA in solution phase. Purification of thedsRNA conjugate by HPLC typically affords the pure conjugate.

Vector Encoded dsRNAs

In another aspect, TTR dsRNA molecules are expressed from transcriptionunits inserted into DNA or RNA vectors (see, e.g., Couture, A, et al.,TIG. (1996), 12:5-10; Skillern, A., et al., International PCTPublication No. WO 00/22113, Conrad, International PCT Publication No.WO 00/22114, and Conrad, U.S. Pat. No. 6,054,299). These transgenes canbe introduced as a linear construct, a circular plasmid, or a viralvector, which can be incorporated and inherited as a transgeneintegrated into the host genome. The transgene can also be constructedto permit it to be inherited as an extrachromosomal plasmid (Gassmann,et al., Proc. Natl. Acad. Sci. USA (1995) 92:1292).

The individual strands of a dsRNA can be transcribed by promoters on twoseparate expression vectors and co-transfected into a target cell.Alternatively each individual strand of the dsRNA can be transcribed bypromoters both of which are located on the same expression plasmid. Inone embodiment, a dsRNA is expressed as an inverted repeat joined by alinker polynucleotide sequence such that the dsRNA has a stem and loopstructure.

The recombinant dsRNA expression vectors are generally DNA plasmids orviral vectors. dsRNA expressing viral vectors can be constructed basedon, but not limited to, adeno-associated virus (for a review, seeMuzyczka, et al., Curr. Topics Micro. Immunol. (1992) 158:97-129));adenovirus (see, for example, Berkner, et al., BioTechniques (1998)6:616), Rosenfeld et al. (1991, Science 252:431-434), and Rosenfeld etal. (1992), Cell 68:143-155)); or alphavirus as well as others known inthe art. Retroviruses have been used to introduce a variety of genesinto many different cell types, including epithelial cells, in vitroand/or in vivo (see, e.g., Eglitis, et al., Science (1985)230:1395-1398; Danos and Mulligan, Proc. Natl. Acad. Sci. USA (1998)85:6460-6464; Wilson et al., 1988, Proc. Natl. Acad. Sci. USA85:3014-3018; Armentano et al., 1990, Proc. Natl. Acad. Sci. USA87:61416145; Huber et al., 1991, Proc. Natl. Acad. Sci. USA88:8039-8043; Ferry et al., 1991, Proc. Natl. Acad. Sci. USA88:8377-8381; Chowdhury et al., 1991, Science 254:1802-1805; vanBeusechem. et al., 1992, Proc. Natl. Acad. Sci. USA 89:7640-19; Kay etal., 1992, Human Gene Therapy 3:641-647; Dai et al., 1992, Proc. Natl.Acad. Sci. USA 89:10892-10895; Hwu et al., 1993, J. Immunol.150:4104-4115; U.S. Pat. No. 4,868,116; U.S. Pat. No. 4,980,286; PCTApplication WO 89/07136; PCT Application WO 89/02468; PCT Application WO89/05345; and PCT Application WO 92/07573). Recombinant retroviralvectors capable of transducing and expressing genes inserted into thegenome of a cell can be produced by transfecting the recombinantretroviral genome into suitable packaging cell lines such as PA317 andPsi-CRIP (Comette et al., 1991, Human Gene Therapy 2:5-10; Cone et al.,1984, Proc. Natl. Acad. Sci. USA 81:6349). Recombinant adenoviralvectors can be used to infect a wide variety of cells and tissues insusceptible hosts (e.g., rat, hamster, dog, and chimpanzee) (Hsu et al.,1992, J. Infectious Disease, 166:769), and also have the advantage ofnot requiring mitotically active cells for infection.

Any viral vector capable of accepting the coding sequences for the dsRNAmolecule(s) to be expressed can be used, for example vectors derivedfrom adenovirus (AV); adeno-associated virus (AAV); retroviruses (e.g,lentiviruses (LV), Rhabdoviruses, murine leukemia virus); herpes virus,and the like. The tropism of viral vectors can be modified bypseudotyping the vectors with envelope proteins or other surfaceantigens from other viruses, or by substituting different viral capsidproteins, as appropriate.

For example, lentiviral vectors featured in the invention can bepseudotyped with surface proteins from vesicular stomatitis virus (VSV),rabies, Ebola, Mokola, and the like. AAV vectors featured in theinvention can be made to target different cells by engineering thevectors to express different capsid protein serotypes. For example, anAAV vector expressing a serotype 2 capsid on a serotype 2 genome iscalled AAV 2/2. This serotype 2 capsid gene in the AAV 2/2 vector can bereplaced by a serotype 5 capsid gene to produce an AAV 2/5 vector.Techniques for constructing AAV vectors which express different capsidprotein serotypes are within the skill in the art; see, e.g., RabinowitzJ E et al. (2002), J Virol 76:791-801, the entire disclosure of which isherein incorporated by reference.

Selection of recombinant viral vectors suitable for use in theinvention, methods for inserting nucleic acid sequences for expressingthe dsRNA into the vector, and methods of delivering the viral vector tothe cells of interest are within the skill in the art. See, for example,Dornburg R (1995), Gene Therap. 2: 301-310; Eglitis M A (1988),Biotechniques 6: 608-614; Miller A D (1990), Hum Gene Therap. 1: 5-14;Anderson W F (1998), Nature 392: 25-30; and Rubinson D A et al., Nat.Genet. 33: 401-406, the entire disclosures of which are hereinincorporated by reference.

Viral vectors can be derived from AV and AAV. In one embodiment, thedsRNA featured in the invention is expressed as two separate,complementary single-stranded RNA molecules from a recombinant AAVvector having, for example, either the U6 or H1 RNA promoters, or thecytomegalovirus (CMV) promoter.

A suitable AV vector for expressing the dsRNA featured in the invention,a method for constructing the recombinant AV vector, and a method fordelivering the vector into target cells, are described in Xia H et al.(2002), Nat. Biotech. 20: 1006-1010.

Suitable AAV vectors for expressing the dsRNA featured in the invention,methods for constructing the recombinant AV vector, and methods fordelivering the vectors into target cells are described in Samulski R etal. (1987), J. Virol. 61: 3096-3101; Fisher K J et al. (1996), J. Virol,70: 520-532; Samulski R et al. (1989), J. Virol. 63: 3822-3826; U.S.Pat. No. 5,252,479; U.S. Pat. No. 5,139,941; International PatentApplication No. WO 94/13788; and International Patent Application No. WO93/24641, the entire disclosures of which are herein incorporated byreference.

The promoter driving dsRNA expression in either a DNA plasmid or viralvector featured in the invention may be a eukaryotic RNA polymerase I(e.g., ribosomal RNA promoter), RNA polymerase II (e.g., CMV earlypromoter or actin promoter or U1 snRNA promoter) or generally RNApolymerase III promoter (e.g., U6 snRNA or 7SK RNA promoter) or aprokaryotic promoter, for example the T7 promoter, provided theexpression plasmid also encodes T7 RNA polymerase required fortranscription from a T7 promoter. The promoter can also direct transgeneexpression to the pancreas (see, e.g., the insulin regulatory sequencefor pancreas (Bucchini et al., 1986, Proc. Natl. Acad. Sci. USA83:2511-2515)).

In addition, expression of the transgene can be precisely regulated, forexample, by using an inducible regulatory sequence and expressionsystems such as a regulatory sequence that is sensitive to certainphysiological regulators, e.g., circulating glucose levels, or hormones(Docherty et al., 1994, FASEB J. 8:20-24). Such inducible expressionsystems, suitable for the control of transgene expression in cells or inmammals include regulation by ecdysone, by estrogen, progesterone,tetracycline, chemical inducers of dimerization, andisopropyl-beta-D1-thiogalactopyranoside (EPTG). A person skilled in theart would be able to choose the appropriate regulatory/promoter sequencebased on the intended use of the dsRNA transgene.

Generally, recombinant vectors capable of expressing dsRNA molecules aredelivered as described below, and persist in target cells.Alternatively, viral vectors can be used that provide for transientexpression of dsRNA molecules. Such vectors can be repeatedlyadministered as necessary. Once expressed, the dsRNAs bind to target RNAand modulate its function or expression. Delivery of dsRNA expressingvectors can be systemic, such as by intravenous or intramuscularadministration, by administration to target cells ex-planted from thepatient followed by reintroduction into the patient, or by any othermeans that allows for introduction into a desired target cell.

dsRNA expression DNA plasmids are typically transfected into targetcells as a complex with cationic lipid carriers (e.g., Oligofectamine)or non-cationic lipid-based carriers (e.g., Transit-TKO™). Multiplelipid transfections for dsRNA-mediated knockdowns targeting differentregions of a single TTR gene or multiple TTR genes over a period of aweek or more are also contemplated by the invention. Successfulintroduction of vectors into host cells can be monitored using variousknown methods. For example, transient transfection can be signaled witha reporter, such as a fluorescent marker, such as Green FluorescentProtein (GFP). Stable transfection of cells ex vivo can be ensured usingmarkers that provide the transfected cell with resistance to specificenvironmental factors (e.g., antibiotics and drugs), such as hygromycinB resistance.

TTR specific dsRNA molecules can also be inserted into vectors and usedas gene therapy vectors for human patients. Gene therapy vectors can bedelivered to a subject by, for example, intravenous injection, localadministration (see U.S. Pat. No. 5,328,470) or by stereotacticinjection (see e.g., Chen et al. (1994) Proc. Natl. Acad. Sci. USA91:3054-3057). The pharmaceutical preparation of the gene therapy vectorcan include the gene therapy vector in an acceptable diluent, or caninclude a slow release matrix in which the gene delivery vehicle isimbedded. Alternatively, where the complete gene delivery vector can beproduced intact from recombinant cells, e.g., retroviral vectors, thepharmaceutical preparation can include one or more cells which producethe gene delivery system.

III. Pharmaceutical Compositions Containing dsRNA

In one embodiment, the invention provides pharmaceutical compositionscontaining a dsRNA, as described herein, and a pharmaceuticallyacceptable carrier. The pharmaceutical composition containing the dsRNAis useful for treating a disease or disorder associated with theexpression or activity of a TTR gene, such as pathological processesmediated by TTR expression. Such pharmaceutical compositions areformulated based on the mode of delivery. One example is compositionsthat are formulated for systemic administration via parenteral delivery,e.g., by intravenous (IV) delivery. Another example is compositions thatare formulated for direct delivery into the brain parenchyma, e.g., byinfusion into the brain, such as by continuous pump infusion.

The pharmaceutical compositions featured herein are administered indosages sufficient to inhibit expression of TTR genes.

In general, a suitable dose of dsRNA will be in the range of 0.01 to200.0 milligrams per kilogram body weight of the recipient per day,generally in the range of 1 to 50 mg per kilogram body weight per day.For example, the dsRNA can be administered at 0.0059 mg/kg, 0.01 mg/kg,0.0295 mg/kg, 0.05 mg/kg, 0.0590 mg/kg, 0.163 mg/kg, 0.2 mg/kg, 0.3mg/kg, 0.4 mg/kg, 0.5 mg/kg, 0.543 mg/kg, 0.5900 mg/kg, 0.6 mg/kg, 0.7mg/kg, 0.8 mg/kg, 0.9 mg/kg, 1 mg/kg, 1.1 mg/kg, 1.2 mg/kg, 1.3 mg/kg,1.4 mg/kg, 1.5 mg/kg, 1.628 mg/kg, 2 mg/kg, 3 mg/kg, 5.0 mg/kg, 10mg/kg, 20 mg/kg, 30 mg/kg, 40 mg/kg, or 50 mg/kg per single dose.

In one embodiment, the dosage is between 0.01 and 0.2 mg/kg. Forexample, the dsRNA can be administered at a dose of 0.01 mg/kg, 0.02mg/kg, 0.3 mg/kg, 0.04 mg/kg, 0.05 mg/kg, 0.06 mg/kg, 0.07 mg/kg 0.08mg/kg 0.09 mg/kg, 0.10 mg/kg, 0.11 mg/kg, 0.12 mg/kg, 0.13 mg/kg, 0.14mg/kg, 0.15 mg/kg, 0.16 mg/kg, 0.17 mg/kg, 0.18 mg/kg, 0.19 mg/kg, or0.20 mg/kg.

In one embodiment, the dosage is between 0.005 mg/kg and 1.628 mg/kg.For example, the dsRNA can be administered at a dose of 0.0059 mg/kg,0.0295 mg/kg, 0.0590 mg/kg, 0.163 mg/kg, 0.543 mg/kg, 0.5900 mg/kg, or1.628 mg/kg.

In one embodiment, the dosage is between 0.2 mg/kg and 1.5 mg/kg. Forexample, the dsRNA can be administered at a dose of 0.2 mg/kg, 0.3mg/kg, 0.4 mg/kg, 0.5 mg/kg, 0.6 mg/kg, 0.7 mg/kg, 0.8 mg/kg, 0.9 mg/kg,1 mg/kg, 1.1 mg/kg, 1.2 mg/kg, 1.3 mg/kg, 1.4 mg/kg, or 1.5 mg/kg.

The pharmaceutical composition may be administered once daily, or thedsRNA may be administered as two, three, or more sub-doses atappropriate intervals throughout the day or even using continuousinfusion or delivery through a controlled release formulation. In thatcase, the dsRNA contained in each sub-dose must be correspondinglysmaller in order to achieve the total daily dosage. The dosage unit canalso be compounded for delivery over several days, e.g., using aconventional sustained release formulation which provides sustainedrelease of the dsRNA over a several day period. Sustained releaseformulations are well known in the art and are particularly useful fordelivery of agents at a particular site, such as could be used with theagents of the present invention. In this embodiment, the dosage unitcontains a corresponding multiple of the daily dose.

The effect of a single dose on TTR levels is long lasting, such thatsubsequent doses are administered at not more than 3, 4, or 5 dayintervals, or at not more than 1, 2, 3, or 4 week intervals, or at notmore than 5, 6, 7, 8, 9, or 10 week intervals.

The skilled artisan will appreciate that certain factors may influencethe dosage and timing required to effectively treat a subject, includingbut not limited to the severity of the disease or disorder, previoustreatments, the general health and/or age of the subject, and otherdiseases present. Moreover, treatment of a subject with atherapeutically effective amount of a composition can include a singletreatment or a series of treatments. Estimates of effective dosages andin vivo half-lives for the individual dsRNAs encompassed by theinvention can be made using conventional methodologies or on the basisof in vivo testing using an appropriate animal model, as describedelsewhere herein.

Advances in mouse genetics have generated a number of mouse models forthe study of various human diseases, such as pathological processesmediated by TTR expression. Such models are used for in vivo testing ofdsRNA, as well as for determining a therapeutically effective dose. Asuitable mouse model is, for example, a mouse containing a plasmidexpressing human TTR. Another suitable mouse model is a transgenic mousecarrying a transgene that expresses human TTR.

The data obtained from cell culture assays and animal studies can beused in formulating a range of dosage for use in humans. The dosage ofcompositions featured in the invention lies generally within a range ofcirculating concentrations that include the ED50 with little or notoxicity. The dosage may vary within this range depending upon thedosage form employed and the route of administration utilized. For anycompound used in the methods featured in the invention, thetherapeutically effective dose can be estimated initially from cellculture assays. A dose may be formulated in animal models to achieve acirculating plasma concentration range of the compound or, whenappropriate, of the polypeptide product of a target sequence (e.g.,achieving a decreased concentration of the polypeptide) that includesthe IC50 (i.e., the concentration of the test compound which achieves ahalf-maximal inhibition of symptoms) as determined in cell culture. Suchinformation can be used to more accurately determine useful doses inhumans. Levels in plasma may be measured, for example, by highperformance liquid chromatography.

The dsRNAs featured in the invention can be administered in combinationwith other known agents effective in treatment of pathological processesmediated by target gene expression. In any event, the administeringphysician can adjust the amount and timing of dsRNA administration onthe basis of results observed using standard measures of efficacy knownin the art or described herein.

Administration

The present invention also includes pharmaceutical compositions andformulations which include the dsRNA compounds featured in theinvention. The pharmaceutical compositions of the present invention maybe administered in a number of ways depending upon whether local orsystemic treatment is desired and upon the area to be treated.Administration may be topical, pulmonary, e.g., by inhalation orinsufflation of powders or aerosols, including by nebulizer;intratracheal, intranasal, epidermal and transdermal, oral orparenteral. Parenteral administration includes intravenous,intraarterial, subcutaneous, intraperitoneal or intramuscular injectionor infusion; or intracranial, e.g., intraparenchymal, intrathecal orintraventricular, administration.

The dsRNA can be delivered in a manner to target a particular tissue,such as the liver (e.g., the hepatocytes of the liver).

The present invention includes pharmaceutical compositions that can bedelivered by injection directly into the brain. The injection can be bystereotactic injection into a particular region of the brain (e.g., thesubstantia nigra, cortex, hippocampus, striatum, or globus pallidus), orthe dsRNA can be delivered into multiple regions of the central nervoussystem (e.g., into multiple regions of the brain, and/or into the spinalcord). The dsRNA can also be delivered into diffuse regions of the brain(e.g., diffuse delivery to the cortex of the brain).

In one embodiment, a dsRNA targeting TTR can be delivered by way of acannula or other delivery device having one end implanted in a tissue,e.g., the brain, e.g., the substantia nigra, cortex, hippocampus,striatum, corpus callosum or globus pallidus of the brain. The cannulacan be connected to a reservoir of the dsRNA composition. The flow ordelivery can be mediated by a pump, e.g., an osmotic pump or minipump,such as an Alzet pump (Durect, Cupertino, Calif.). In one embodiment, apump and reservoir are implanted in an area distant from the tissue,e.g., in the abdomen, and delivery is effected by a conduit leading fromthe pump or reservoir to the site of release. Infusion of the dsRNAcomposition into the brain can be over several hours or for severaldays, e.g., for 1, 2, 3, 5, or 7 days or more. Devices for delivery tothe brain are described, for example, in U.S. Pat. Nos. 6,093,180, and5,814,014.

Pharmaceutical compositions and formulations for topical administrationmay include transdermal patches, ointments, lotions, creams, gels,drops, suppositories, sprays, liquids and powders. Conventionalpharmaceutical carriers, aqueous, powder or oily bases, thickeners andthe like may be necessary or desirable. Coated condoms, gloves and thelike may also be useful. Suitable topical formulations include those inwhich the dsRNAs featured in the invention are in admixture with atopical delivery agent such as lipids, liposomes, fatty acids, fattyacid esters, steroids, chelating agents and surfactants. Suitable lipidsand liposomes include neutral (e.g., dioleoylphosphatidyl DOPEethanolamine, dimyristoylphosphatidyl choline DMPC,distearoylphosphatidyl choline) negative (e.g., dimyristoylphosphatidylglycerol DMPG) and cationic (e.g., dioleoyltetramethylaminopropyl DOTAPand dioleoylphosphatidyl ethanolamine DOTMA). DsRNAs featured in theinvention may be encapsulated within liposomes or may form complexesthereto, in particular to cationic liposomes. Alternatively, dsRNAs maybe complexed to lipids, in particular to cationic lipids. Suitable fattyacids and esters include but are not limited to arachidonic acid, oleicacid, eicosanoic acid, lauric acid, caprylic acid, capric acid, myristicacid, palmitic acid, stearic acid, linoleic acid, linolenic acid,dicaprate, tricaprate, monoolein, dilaurin, glyceryl 1-monocaprate,1-dodecylazacycloheptan-2-one, an acylcarnitine, an acylcholine, or aC₁₋₁₀ alkyl ester (e.g., isopropylmyristate IPM), monoglyceride,diglyceride or pharmaceutically acceptable salt thereof. Topicalformulations are described in detail in U.S. Pat. No. 6,747,014, whichis incorporated herein by reference.

Liposomal Formulations

There are many organized surfactant structures besides microemulsionsthat have been studied and used for the formulation of drugs. Theseinclude monolayers, micelles, bilayers and vesicles. Vesicles, such asliposomes, have attracted great interest because of their specificityand the duration of action they offer from the standpoint of drugdelivery. As used in the present invention, the term “liposome” means avesicle composed of amphiphilic lipids arranged in a spherical bilayeror bilayers.

Liposomes are unilamellar or multilamellar vesicles which have amembrane formed from a lipophilic material and an aqueous interior. Theaqueous portion contains the composition to be delivered. Cationicliposomes possess the advantage of being able to fuse to the cell wall.Non-cationic liposomes, although not able to fuse as efficiently withthe cell wall, are taken up by macrophages in vivo.

In order to cross intact mammalian skin, lipid vesicles must passthrough a series of fine pores, each with a diameter less than 50 nm,under the influence of a suitable transdermal gradient. Therefore, it isdesirable to use a liposome which is highly deformable and able to passthrough such fine pores.

Further advantages of liposomes include; liposomes obtained from naturalphospholipids are biocompatible and biodegradable; liposomes canincorporate a wide range of water and lipid soluble drugs; liposomes canprotect encapsulated drugs in their internal compartments frommetabolism and degradation (Rosoff, in Pharmaceutical Dosage Forms,Lieberman, Rieger and Banker (Eds.), 1988, Marcel Dekker, Inc., NewYork, N.Y., volume 1, p. 245). Important considerations in thepreparation of liposome formulations are the lipid surface charge,vesicle size and the aqueous volume of the liposomes.

Liposomes are useful for the transfer and delivery of active ingredientsto the site of action. Because the liposomal membrane is structurallysimilar to biological membranes, when liposomes are applied to a tissue,the liposomes start to merge with the cellular membranes and as themerging of the liposome and cell progresses, the liposomal contents areemptied into the cell where the active agent may act.

Liposomal formulations have been the focus of extensive investigation asthe mode of delivery for many drugs. There is growing evidence that fortopical administration, liposomes present several advantages over otherformulations. Such advantages include reduced side-effects related tohigh systemic absorption of the administered drug, increasedaccumulation of the administered drug at the desired target, and theability to administer a wide variety of drugs, both hydrophilic andhydrophobic, into the skin.

Several reports have detailed the ability of liposomes to deliver agentsincluding high-molecular weight DNA into the skin. Compounds includinganalgesics, antibodies, hormones and high-molecular weight DNAs havebeen administered to the skin. The majority of applications resulted inthe targeting of the upper epidermis

Liposomes fall into two broad classes. Cationic liposomes are positivelycharged liposomes which interact with the negatively charged DNAmolecules to form a stable complex. The positively charged DNA/liposomecomplex binds to the negatively charged cell surface and is internalizedin an endosome. Due to the acidic pH within the endosome, the liposomesare ruptured, releasing their contents into the cell cytoplasm (Wang etal., Biochem. Biophys. Res. Commun., 1987, 147, 980-985).

Liposomes which are pH-sensitive or negatively-charged, entrap DNArather than complex with it. Since both the DNA and the lipid aresimilarly charged, repulsion rather than complex formation occurs.Nevertheless, some DNA is entrapped within the aqueous interior of theseliposomes. pH-sensitive liposomes have been used to deliver DNA encodingthe thymidine kinase gene to cell monolayers in culture. Expression ofthe exogenous gene was detected in the target cells (Zhou et al.,Journal of Controlled Release, 1992, 19, 269-274).

One major type of liposomal composition includes phospholipids otherthan naturally-derived phosphatidylcholine. Neutral liposomecompositions, for example, can be formed from dimyristoylphosphatidylcholine (DMPC) or dipalmitoyl phosphatidylcholine (DPPC).Anionic liposome compositions generally are formed from dimyristoylphosphatidylglycerol, while anionic fusogenic liposomes are formedprimarily from dioleoyl phosphatidylethanolamine (DOPE). Another type ofliposomal composition is formed from phosphatidylcholine (PC) such as,for example, soybean PC, and egg PC. Another type is formed frommixtures of phospholipid and/or phosphatidylcholine and/or cholesterol.

Several studies have assessed the topical delivery of liposomal drugformulations to the skin. Application of liposomes containing interferonto guinea pig skin resulted in a reduction of skin herpes sores whiledelivery of interferon via other means (e.g., as a solution or as anemulsion) were ineffective (Weiner et al., Journal of Drug Targeting,1992, 2, 405-410). Further, an additional study tested the efficacy ofinterferon administered as part of a liposomal formulation to theadministration of interferon using an aqueous system, and concluded thatthe liposomal formulation was superior to aqueous administration (duPlessis et al., Antiviral Research, 1992, 18, 259-265).

Non-ionic liposomal systems have also been examined to determine theirutility in the delivery of drugs to the skin, in particular systemscomprising non-ionic surfactant and cholesterol. Non-ionic liposomalformulations comprising Novasome™ I (glyceryldilaurate/cholesterol/polyoxyethylene-10-stearyl ether) and Novasome™ II(glyceryl distearate/cholesterol/polyoxyethylene-10-stearyl ether) wereused to deliver cyclosporin-A into the dermis of mouse skin. Resultsindicated that such non-ionic liposomal systems were effective infacilitating the deposition of cyclosporin-A into different layers ofthe skin (Hu et al. S.T.P. Pharma. Sci., 1994, 4, 6, 466).

Liposomes also include “sterically stabilized” liposomes, a term which,as used herein, refers to liposomes comprising one or more specializedlipids that, when incorporated into liposomes, result in enhancedcirculation lifetimes relative to liposomes lacking such specializedlipids. Examples of sterically stabilized liposomes are those in whichpart of the vesicle-forming lipid portion of the liposome (A) comprisesone or more glycolipids, such as monosialoganglioside G_(M1), or (B) isderivatized with one or more hydrophilic polymers, such as apolyethylene glycol (PEG) moiety. While not wishing to be bound by anyparticular theory, it is thought in the art that, at least forsterically stabilized liposomes containing gangliosides, sphingomyelin,or PEG-derivatized lipids, the enhanced circulation half-life of thesesterically stabilized liposomes derives from a reduced uptake into cellsof the reticuloendothelial system (RES) (Allen et al., FEBS Letters,1987, 223, 42; Wu et al., Cancer Research, 1993, 53, 3765).

Various liposomes comprising one or more glycolipids are known in theart. Papahadjopoulos et al. (Ann. N.Y. Acad. Sci., 1987, 507, 64)reported the ability of monosialoganglioside G_(M1), galactocerebrosidesulfate and phosphatidylinositol to improve blood half-lives ofliposomes. These findings were expounded upon by Gabizon et al. (Proc.Natl. Acad. Sci. U.S.A., 1988, 85, 6949). U.S. Pat. No. 4,837,028 and WO88/04924, both to Allen et al., disclose liposomes comprising (1)sphingomyelin and (2) the ganglioside G_(M1) or a galactocerebrosidesulfate ester. U.S. Pat. No. 5,543,152 (Webb et al.) discloses liposomescomprising sphingomyelin. Liposomes comprising1,2-sn-dimyristoylphosphatidylcholine are disclosed in WO 97/13499 (Limet al).

Many liposomes comprising lipids derivatized with one or morehydrophilic polymers, and methods of preparation thereof, are known inthe art. Sunamoto et al. (Bull. Chem. Soc. Jpn., 1980, 53, 2778)described liposomes comprising a nonionic detergent, 2C_(1215G), thatcontains a PEG moiety. Illum et al. (FEBS Lett., 1984, 167, 79) notedthat hydrophilic coating of polystyrene particles with polymeric glycolsresults in significantly enhanced blood half-lives. Syntheticphospholipids modified by the attachment of carboxylic groups ofpolyalkylene glycols (e.g., PEG) are described by Sears (U.S. Pat. Nos.4,426,330 and 4,534,899). Klibanov et al. (FEBS Lett., 1990, 268, 235)described experiments demonstrating that liposomes comprisingphosphatidylethanolamine (PE) derivatized with PEG or PEG stearate havesignificant increases in blood circulation half-lives. Blume et al.(Biochimica et Biophysica Acta, 1990, 1029, 91) extended suchobservations to other PEG-derivatized phospholipids, e.g., DSPE-PEG,formed from the combination of distearoylphosphatidylethanolamine (DSPE)and PEG. Liposomes having covalently bound PEG moieties on theirexternal surface are described in European Patent No. EP 0 445 131 B1and WO 90/04384 to Fisher. Liposome compositions containing 1-20 molepercent of PE derivatized with PEG, and methods of use thereof, aredescribed by Woodle et al. (U.S. Pat. Nos. 5,013,556 and 5,356,633) andMartin et al. (U.S. Pat. No. 5,213,804 and European Patent No. EP 0 496813 B1). Liposomes comprising a number of other lipid-polymer conjugatesare disclosed in WO 91/05545 and U.S. Pat. No. 5,225,212 (both to Martinet al.) and in WO 94/20073 (Zalipsky et al.) Liposomes comprisingPEG-modified ceramide lipids are described in WO 96/10391 (Choi et al).U.S. Pat. No. 5,540,935 (Miyazaki et al.) and U.S. Pat. No. 5,556,948(Tagawa et al.) describe PEG-containing liposomes that can be furtherderivatized with functional moieties on their surfaces.

A number of liposomes comprising nucleic acids are known in the art. WO96/40062 to Thierry et al. discloses methods for encapsulating highmolecular weight nucleic acids in liposomes. U.S. Pat. No. 5,264,221 toTagawa et al. discloses protein-bonded liposomes and asserts that thecontents of such liposomes may include a dsRNA. U.S. Pat. No. 5,665,710to Rahman et al. describes certain methods of encapsulatingoligodeoxynucleotides in liposomes. WO 97/04787 to Love et al. disclosesliposomes comprising dsRNAs targeted to the raf gene.

Transfersomes are yet another type of liposomes, and are highlydeformable lipid aggregates which are attractive candidates for drugdelivery vehicles. Transfersomes may be described as lipid dropletswhich are so highly deformable that they are easily able to penetratethrough pores which are smaller than the droplet. Transfersomes areadaptable to the environment in which they are used, e.g., they areself-optimizing (adaptive to the shape of pores in the skin),self-repairing, frequently reach their targets without fragmenting, andoften self-loading. To make transfersomes it is possible to add surfaceedge-activators, usually surfactants, to a standard liposomalcomposition. Transfersomes have been used to deliver serum albumin tothe skin. The transfersome-mediated delivery of serum albumin has beenshown to be as effective as subcutaneous injection of a solutioncontaining serum albumin.

Surfactants find wide application in formulations such as emulsions(including microemulsions) and liposomes. The most common way ofclassifying and ranking the properties of the many different types ofsurfactants, both natural and synthetic, is by the use of thehydrophile/lipophile balance (HLB). The nature of the hydrophilic group(also known as the “head”) provides the most useful means forcategorizing the different surfactants used in formulations (Rieger, inPharmaceutical Dosage Forms, Marcel Dekker, Inc., New York, N.Y., 1988,p. 285).

If the surfactant molecule is not ionized, it is classified as anonionic surfactant. Nonionic surfactants find wide application inpharmaceutical and cosmetic products and are usable over a wide range ofpH values. In general their HLB values range from 2 to about 18depending on their structure. Nonionic surfactants include nonionicesters such as ethylene glycol esters, propylene glycol esters, glycerylesters, polyglyceryl esters, sorbitan esters, sucrose esters, andethoxylated esters. Nonionic alkanolamides and ethers such as fattyalcohol ethoxylates, propoxylated alcohols, and ethoxylated/propoxylatedblock polymers are also included in this class. The polyoxyethylenesurfactants are the most popular members of the nonionic surfactantclass.

If the surfactant molecule carries a negative charge when it isdissolved or dispersed in water, the surfactant is classified asanionic. Anionic surfactants include carboxylates such as soaps, acyllactylates, acyl amides of amino acids, esters of sulfuric acid such asalkyl sulfates and ethoxylated alkyl sulfates, sulfonates such as alkylbenzene sulfonates, acyl isethionates, acyl taurates andsulfosuccinates, and phosphates. The most important members of theanionic surfactant class are the alkyl sulfates and the soaps.

If the surfactant molecule carries a positive charge when it isdissolved or dispersed in water, the surfactant is classified ascationic. Cationic surfactants include quaternary ammonium salts andethoxylated amines. The quaternary ammonium salts are the most usedmembers of this class.

If the surfactant molecule has the ability to carry either a positive ornegative charge, the surfactant is classified as amphoteric. Amphotericsurfactants include acrylic acid derivatives, substituted alkylamides,N-alkylbetaines and phosphatides.

The use of surfactants in drug products, formulations and in emulsionshas been reviewed (Rieger, in Pharmaceutical Dosage Forms, MarcelDekker, Inc., New York, N.Y., 1988, p. 285).

Nucleic Acid Lipid Particles

In one embodiment, a TTR dsRNA featured in the invention is fullyencapsulated in the lipid formulation, e.g., to form a SPLP, pSPLP,SNALP, or other nucleic acid-lipid particle. As used herein, the term“SNALP” refers to a stable nucleic acid-lipid particle, including SPLP.As used herein, the term “SPLP” refers to a nucleic acid-lipid particlecomprising plasmid DNA encapsulated within a lipid vesicle. SNALPs andSPLPs typically contain a cationic lipid, a non-cationic lipid, and alipid that prevents aggregation of the particle (e.g., a PEG-lipidconjugate). SNALPs and SPLPs are extremely useful for systemicapplications, as they exhibit extended circulation lifetimes followingintravenous (i.v.) injection and accumulate at distal sites (e.g., sitesphysically separated from the administration site). SPLPs include“pSPLP,” which include an encapsulated condensing agent-nucleic acidcomplex as set forth in PCT Publication No. WO 00/03683. The particlesof the present invention typically have a mean diameter of about 50 nmto about 150 nm, more typically about 60 nm to about 130 nm, moretypically about 70 nm to about 110 nm, most typically about 70 nm toabout 90 nm, and are substantially nontoxic. In addition, the nucleicacids when present in the nucleic acid-lipid particles of the presentinvention are resistant in aqueous solution to degradation with anuclease. Nucleic acid-lipid particles and their method of preparationare disclosed in, e.g., U.S. Pat. Nos. 5,976,567; 5,981,501; 6,534,484;6,586,410; 6,815,432; and PCT Publication No. WO 96/40964.

In one embodiment, the lipid to drug ratio (mass/mass ratio) (e.g.,lipid to dsRNA ratio) will be in the range of from about 1:1 to about50:1, from about 1:1 to about 25:1, from about 3:1 to about 15:1, fromabout 4:1 to about 10:1, from about 5:1 to about 9:1, or about 6:1 toabout 9:1.

The cationic lipid may be, for example, N,N-dioleyl-N,N-dimethylammoniumchloride (DODAC), N,N-distearyl-N,N-dimethylammonium bromide (DDAB),N-(1-(2,3-dioleoyloxy)propyl)-N,N,N-trimethylammonium chloride (DOTAP),N-(1-(2,3-dioleyloxy)propyl)-N,N,N-trimethylammonium chloride (DOTMA),N,N-dimethyl-2,3-dioleyloxy)propylamine (DODMA),1,2-DiLinoleyloxy-N,N-dimethylaminopropane (DLinDMA),1,2-Dilinolenyloxy-N,N-dimethylaminopropane (DLenDMA),1,2-Dilinoleylcarbamoyloxy-3-dimethylaminopropane (DLin-C-DAP),1,2-Dilinoleyoxy-3-(dimethylamino)acetoxypropane (DLin-DAC),1,2-Dilinoleyoxy-3-morpholinopropane (DLin-MA),1,2-Dilinoleoyl-3-dimethylaminopropane (DLinDAP),1,2-Dilinoleylthio-3-dimethylaminopropane (DLin-S-DMA),1-Linoleoyl-2-linoleyloxy-3-dimethylaminopropane (DLin-2-DMAP),1,2-Dilinoleyloxy-3-trimethylaminopropane chloride salt (DLin-TMA.Cl),1,2-Dilinoleoyl-3-trimethylaminopropane chloride salt (DLin-TAP.Cl),1,2-Dilinoleyloxy-3-(N-methylpiperazino)propane (DLin-MPZ), or3-(N,N-Dilinoleylamino)-1,2-propanediol (DLinAP),3-(N,N-Dioleylamino)-1,2-propanedio (DOAP),1,2-Dilinoleyloxo-3-(2-N,N-dimethylamino)ethoxypropane (DLin-EG-DMA),1,2-Dilinolenyloxy-N,N-dimethylaminopropane (DLinDMA),2,2-Dilinoleyl-4-dimethylaminomethyl-[1,3]-dioxolane (DLin-K-DMA) oranalogs thereof,(3aR,5s,6aS)—N,N-dimethyl-2,2-di((9Z,12Z)-octadeca-9,12-dienyl)tetrahydro-3aH-cyclopenta[d][1,3]dioxol-5-amine(ALN100),(6Z,9Z,28Z,31Z)-heptatriaconta-6,9,28,31-tetraen-19-yl-4-(dimethylamino)butanoate(MC3),1,1′-(2-(4-(2-((2-(bis(2-hydroxydodecyl)amino)ethyl)(2-hydroxydodecyl)amino)ethyl)piperazin-1-yl)ethylazanediyl)didodecan-2-ol(Tech G1), or a mixture thereof. The cationic lipid may comprise fromabout 20 mol % to about 50 mol % or about 40 mol % of the total lipidpresent in the particle.

In another embodiment, the compound2,2-Dilinoleyl-4-dimethylaminoethyl-[1,3]-dioxolane can be used toprepare lipid-siRNA nanoparticles. Synthesis of2,2-Dilinoleyl-4-dimethylaminoethyl-[1,3]-dioxolane is described in U.S.provisional patent application No. 61/107,998 filed on Oct. 23, 2008,which is herein incorporated by reference.

In one embodiment, the lipid-siRNA particle includes 40%2,2-Dilinoleyl-4-dimethylaminoethyl-[1,3]-dioxolane: 10% DSPC: 40%Cholesterol: 10% PEG-C-DOMG (mole percent) with a particle size of63.0±20 nm and a 0.027 siRNA/Lipid Ratio.

The non-cationic lipid may be an anionic lipid or a neutral lipidincluding, but not limited to, distearoylphosphatidylcholine (DSPC),dioleoylphosphatidylcholine (DOPC), dipalmitoylphosphatidylcholine(DPPC), dioleoylphosphatidylglycerol (DOPG),dipalmitoylphosphatidylglycerol (DPPG),dioleoyl-phosphatidylethanolamine (DOPE),palmitoyloleoylphosphatidylcholine (POPC),palmitoyloleoylphosphatidylethanolamine (POPE),dioleoyl-phosphatidylethanolamine4-(N-maleimidomethyl)-cyclohexane-1-carboxylate (DOPE-mal), dipalmitoylphosphatidyl ethanolamine (DPPE), dimyristoylphosphoethanolamine (DMPE),distearoyl-phosphatidyl-ethanolamine (DSPE), 16-O-monomethyl PE,16-O-dimethyl PE, 18-1-trans PE,1-stearoyl-2-oleoyl-phosphatidyethanolamine (SOPE), cholesterol, or amixture thereof. The non-cationic lipid may be from about 5 mol % toabout 90 mol %, about 10 mol %, or about 58 mol % if cholesterol isincluded, of the total lipid present in the particle.

The conjugated lipid that inhibits aggregation of particles may be, forexample, a polyethyleneglycol (PEG)-lipid including, without limitation,a PEG-diacylglycerol (DAG), a PEG-dialkyloxypropyl (DAA), aPEG-phospholipid, a PEG-ceramide (Cer), or a mixture thereof. ThePEG-DAA conjugate may be, for example, a PEG-dilauryloxypropyl (Ci₂), aPEG-dimyristyloxypropyl (Ci₄), a PEG-dipalmityloxypropyl (Ci₆), or aPEG-distearyloxypropyl (C]₈). The conjugated lipid that preventsaggregation of particles may be from 0 mol % to about 20 mol % or about2 mol % of the total lipid present in the particle.

In some embodiments, the nucleic acid-lipid particle further includescholesterol at, e.g., about 10 mol % to about 60 mol % or about 48 mol %of the total lipid present in the particle.

LNP01

In one embodiment, the lipidoid ND98.4HCl (MW 1487) (Formula 1),Cholesterol (Sigma-Aldrich), and PEG-Ceramide C16 (Avanti Polar Lipids)can be used to prepare lipid-siRNA nanoparticles (i.e., LNP01particles). Stock solutions of each in ethanol can be prepared asfollows: ND98, 133 mg/ml; Cholesterol, 25 mg/ml, PEG-Ceramide C16, 100mg/ml. The ND98, Cholesterol, and PEG-Ceramide C16 stock solutions canthen be combined in a, e.g., 42:48:10 molar ratio. The combined lipidsolution can be mixed with aqueous siRNA (e.g., in sodium acetate pH 5)such that the final ethanol concentration is about 35-45% and the finalsodium acetate concentration is about 100-300 mM. Lipid-siRNAnanoparticles typically form spontaneously upon mixing. Depending on thedesired particle size distribution, the resultant nanoparticle mixturecan be extruded through a polycarbonate membrane (e.g., 100 nm cut-off)using, for example, a thermobarrel extruder, such as Lipex Extruder(Northern Lipids, Inc). In some cases, the extrusion step can beomitted. Ethanol removal and simultaneous buffer exchange can beaccomplished by, for example, dialysis or tangential flow filtration.Buffer can be exchanged with, for example, phosphate buffered saline(PBS) at about pH 7, e.g., about pH 6.9, about pH 7.0, about pH 7.1,about pH 7.2, about pH 7.3, or about pH 7.4.

LNP01 formulations are described, e.g., in International ApplicationPublication No. WO 2008/042973, which is hereby incorporated byreference.

Additional exemplary lipid-siRNA formulations are as follows:

cationic lipid/non-cationic lipid/cholesterol/PEG-lipid conjugateCationic Lipid Lipid:siRNA ratio Process SNALP 1,2-Dilinolenyloxy-N,N-DLinDMA/DPPC/Cholesterol/PEG- dimethylaminopropane (DLinDMA) cDMA(57.1/7.1/34.4/1.4) lipid:siRNA ~ 7:1 SNALP-2,2-Dilinoleyl-4-dimethylaminoethyl- XTC/DPPC/Cholesterol/PEG-cDMA XTC[1,3]-dioxolane (XTC) 57.1/7.1/34.4/1.4 lipid:siRNA ~ 7:1 LNP052,2-Dilinoleyl-4-dimethylaminoethyl- XTC/DSPC/Cholesterol/PEG-DMGExtrusion [1,3]-dioxolane (XTC) 57.5/7.5/31.5/3.5 lipid:siRNA ~ 6:1LNP06 2,2-Dilinoleyl-4-dimethylaminoethyl- XTC/DSPC/Cholesterol/PEG-DMGExtrusion [1,3]-dioxolane (XTC) 57.5/7.5/31.5/3.5 lipid:siRNA ~ 11:1LNP07 2,2-Dilinoleyl-4-dimethylaminoethyl- XTC/DSPC/Cholesterol/PEG-DMGIn-line [1,3]-dioxolane (XTC) 60/7.5/31/1.5, mixing lipid:siRNA ~ 6:1LNP08 2,2-Dilinoleyl-4-dimethylaminoethyl- XTC/DSPC/Cholesterol/PEG-DMGIn-line [1,3]-dioxolane (XTC) 60/7.5/31/1.5, mixing lipid:siRNA ~ 11:1LNP09 2,2-Dilinoleyl-4-dimethylaminoethyl- XTC/DSPC/Cholesterol/PEG-DMGIn-line [1,3]-dioxolane (XTC) 50/10/38.5/1.5 mixing Lipid:siRNA 10:1LNP10 (3aR,5s,6aS)-N,N-dimethyl-2,2- ALN100/DSPC/Cholesterol/PEG-DMGIn-line di((9Z,12Z)-octadeca-9,12- 50/10/38.5/1.5 mixingdienyl)tetrahydro-3aH- Lipid:siRNA 10:1 cyclopenta[d][1,3]dioxol-5-amine(ALN100) LNP11 (6Z,9Z,28Z,31Z)-heptatriaconta-MC-3/DSPC/Cholesterol/PEG-DMG In-line 6,9,28,31-tetraen-19-yl 4-50/10/38.5/1.5 mixing (dimethylamino)butanoate (MC3) Lipid:siRNA 10:1LNP12 1,1′-(2-(4-(2-((2-(bis(2- Tech G1/DSPC/Cholesterol/PEG-DMG In-linehydroxydodecyl)amino)ethyl)(2- 50/10/38.5/1.5 mixinghydroxydodecyl)amino)ethyl)piperazin- Lipid:siRNA 10:11-yl)ethylazanediyl)didodecan-2-ol (Tech G1)

LNP09 formulations and XTC comprising formulations are described, e.g.,in U.S. Provisional Ser. No. 61/239,686, filed Sep. 3, 2009, which ishereby incorporated by reference. LNP11 formulations and MC3 comprisingformulations are described, e.g., in U.S. Provisional Ser. No.61/244,834, filed Sep. 22, 2009, which is hereby incorporated byreference.

Formulations prepared by either the standard or extrusion-free methodcan be characterized in similar manners. For example, formulations aretypically characterized by visual inspection. They should be whitishtranslucent solutions free from aggregates or sediment. Particle sizeand particle size distribution of lipid-nanoparticles can be measured bylight scattering using, for example, a Malvern Zetasizer Nano ZS(Malvern, USA). Particles should be about 20-300 nm, such as 40-100 nmin size. The particle size distribution should be unimodal. The totalsiRNA concentration in the formulation, as well as the entrappedfraction, is estimated using a dye exclusion assay. A sample of theformulated siRNA can be incubated with an RNA-binding dye, such asRibogreen (Molecular Probes) in the presence or absence of a formulationdisrupting surfactant, e.g., 0.5% Triton-X100. The total siRNA in theformulation can be determined by the signal from the sample containingthe surfactant, relative to a standard curve. The entrapped fraction isdetermined by subtracting the “free” siRNA content (as measured by thesignal in the absence of surfactant) from the total siRNA content.Percent entrapped siRNA is typically >85%. For SNALP formulation, theparticle size is at least 30 nm, at least 40 nm, at least 50 nm, atleast 60 nm, at least 70 nm, at least 80 nm, at least 90 nm, at least100 nm, at least 110 nm, and at least 120 nm. The suitable range istypically about at least 50 nm to about at least 110 nm, about at least60 nm to about at least 100 nm, or about at least 80 nm to about atleast 90 nm.

Compositions and formulations for oral administration include powders orgranules, microparticulates, nanoparticulates, suspensions or solutionsin water or non-aqueous media, capsules, gel capsules, sachets, tabletsor minitablets. Thickeners, flavoring agents, diluents, emulsifiers,dispersing aids or binders may be desirable. In some embodiments, oralformulations are those in which dsRNAs featured in the invention areadministered in conjunction with one or more penetration enhancerssurfactants and chelators. Suitable surfactants include fatty acidsand/or esters or salts thereof, bile acids and/or salts thereof.Suitable bile acids/salts include chenodeoxycholic acid (CDCA) andursodeoxychenodeoxycholic acid (UDCA), cholic acid, dehydrocholic acid,deoxycholic acid, glucholic acid, glycholic acid, glycodeoxycholic acid,taurocholic acid, taurodeoxycholic acid, sodiumtauro-24,25-dihydro-fusidate and sodium glycodihydrofusidate. Suitablefatty acids include arachidonic acid, undecanoic acid, oleic acid,lauric acid, caprylic acid, capric acid, myristic acid, palmitic acid,stearic acid, linoleic acid, linolenic acid, dicaprate, tricaprate,monoolein, dilaurin, glyceryl 1-monocaprate,1-dodecylazacycloheptan-2-one, an acylcarnitine, an acylcholine, or amonoglyceride, a diglyceride or a pharmaceutically acceptable saltthereof (e.g., sodium). In some embodiments, combinations of penetrationenhancers are used, for example, fatty acids/salts in combination withbile acids/salts. One exemplary combination is the sodium salt of lauricacid, capric acid and UDCA. Further penetration enhancers includepolyoxyethylene-9-lauryl ether, polyoxyethylene-20-cetyl ether. DsRNAsfeatured in the invention may be delivered orally, in granular formincluding sprayed dried particles, or complexed to form micro ornanoparticles. DsRNA complexing agents include poly-amino acids;polyimines; polyacrylates; polyalkylacrylates, polyoxethanes,polyalkylcyanoacrylates; cationized gelatins, albumins, starches,acrylates, polyethyleneglycols (PEG) and starches;polyalkylcyanoacrylates; DEAE-derivatized polyimines, pollulans,celluloses and starches. Suitable complexing agents include chitosan,N-trimethylchitosan, poly-L-lysine, polyhistidine, polyornithine,polyspermines, protamine, polyvinylpyridine,polythiodiethylaminomethylethylene P(TDAE), polyaminostyrene (e.g.,p-amino), poly(methylcyanoacrylate), poly(ethylcyanoacrylate),poly(butylcyanoacrylate), poly(isobutylcyanoacrylate),poly(isohexylcynaoacrylate), DEAE-methacrylate, DEAE-hexylacrylate,DEAE-acrylamide, DEAE-albumin and DEAE-dextran, polymethylacrylate,polyhexylacrylate, poly(D,L-lactic acid), poly(DL-lactic-co-glycolicacid (PLGA), alginate, and polyethyleneglycol (PEG). Oral formulationsfor dsRNAs and their preparation are described in detail in U.S. Pat.No. 6,887,906, US Publn. No. 20030027780, and U.S. Pat. No. 6,747,014,each of which is incorporated herein by reference.

Compositions and formulations for parenteral, intraparenchymal (into thebrain), intrathecal, intraventricular or intrahepatic administration mayinclude sterile aqueous solutions which may also contain buffers,diluents and other suitable additives such as, but not limited to,penetration enhancers, carrier compounds and other pharmaceuticallyacceptable carriers or excipients.

Pharmaceutical compositions of the present invention include, but arenot limited to, solutions, emulsions, and liposome-containingformulations. These compositions may be generated from a variety ofcomponents that include, but are not limited to, preformed liquids,self-emulsifying solids and self-emulsifying semisolids. Particularlypreferred are formulations that target the liver when treating hepaticdisorders such as hepatic carcinoma.

The pharmaceutical formulations of the present invention, which mayconveniently be presented in unit dosage form, may be prepared accordingto conventional techniques well known in the pharmaceutical industry.Such techniques include the step of bringing into association the activeingredients with the pharmaceutical carrier(s) or excipient(s). Ingeneral, the formulations are prepared by uniformly and intimatelybringing into association the active ingredients with liquid carriers orfinely divided solid carriers or both, and then, if necessary, shapingthe product.

The compositions of the present invention may be formulated into any ofmany possible dosage forms such as, but not limited to, tablets,capsules, gel capsules, liquid syrups, soft gels, suppositories, andenemas. The compositions of the present invention may also be formulatedas suspensions in aqueous, non-aqueous or mixed media. Aqueoussuspensions may further contain substances which increase the viscosityof the suspension including, for example, sodium carboxymethylcellulose,sorbitol and/or dextran. The suspension may also contain stabilizers.

Emulsions

The compositions of the present invention may be prepared and formulatedas emulsions. Emulsions are typically heterogeneous systems of oneliquid dispersed in another in the form of droplets usually exceeding0.1 μm in diameter (Idson, in Pharmaceutical Dosage Forms, Lieberman,Rieger and Banker (Eds.), 1988, Marcel Dekker, Inc., New York, N.Y.,volume 1, p. 199; Rosoff, in Pharmaceutical Dosage Forms, Lieberman,Rieger and Banker (Eds.), 1988, Marcel Dekker, Inc., New York, N.Y.,Volume 1, p. 245; Block in Pharmaceutical Dosage Forms, Lieberman,Rieger and Banker (Eds.), 1988, Marcel Dekker, Inc., New York, N.Y.,volume 2, p. 335; Higuchi et al., in Remington's PharmaceuticalSciences, Mack Publishing Co., Easton, Pa., 1985, p. 301). Emulsions areoften biphasic systems comprising two immiscible liquid phasesintimately mixed and dispersed with each other. In general, emulsionsmay be of either the water-in-oil (w/o) or the oil-in-water (o/w)variety. When an aqueous phase is finely divided into and dispersed asminute droplets into a bulk oily phase, the resulting composition iscalled a water-in-oil (w/o) emulsion. Alternatively, when an oily phaseis finely divided into and dispersed as minute droplets into a bulkaqueous phase, the resulting composition is called an oil-in-water (o/w)emulsion. Emulsions may contain additional components in addition to thedispersed phases, and the active drug which may be present as a solutionin either the aqueous phase, oily phase or itself as a separate phase.Pharmaceutical excipients such as emulsifiers, stabilizers, dyes, andanti-oxidants may also be present in emulsions as needed. Pharmaceuticalemulsions may also be multiple emulsions that are comprised of more thantwo phases such as, for example, in the case of oil-in-water-in-oil(o/w/o) and water-in-oil-in-water (w/o/w) emulsions. Such complexformulations often provide certain advantages that simple binaryemulsions do not. Multiple emulsions in which individual oil droplets ofan o/w emulsion enclose small water droplets constitute a w/o/wemulsion. Likewise a system of oil droplets enclosed in globules ofwater stabilized in an oily continuous phase provides an o/w/o emulsion.

Emulsions are characterized by little or no thermodynamic stability.Often, the dispersed or discontinuous phase of the emulsion is welldispersed into the external or continuous phase and maintained in thisform through the means of emulsifiers or the viscosity of theformulation. Either of the phases of the emulsion may be a semisolid ora solid, as is the case of emulsion-style ointment bases and creams.Other means of stabilizing emulsions entail the use of emulsifiers thatmay be incorporated into either phase of the emulsion. Emulsifiers maybroadly be classified into four categories: synthetic surfactants,naturally occurring emulsifiers, absorption bases, and finely dispersedsolids (Idson, in Pharmaceutical Dosage Forms, Lieberman, Rieger andBanker (Eds.), 1988, Marcel Dekker, Inc., New York, N.Y., volume 1, p.199).

Synthetic surfactants, also known as surface active agents, have foundwide applicability in the formulation of emulsions and have beenreviewed in the literature (Rieger, in Pharmaceutical Dosage Forms,Lieberman, Rieger and Banker (Eds.), 1988, Marcel Dekker, Inc., NewYork, N.Y., volume 1, p. 285; Idson, in Pharmaceutical Dosage Forms,Lieberman, Rieger and Banker (Eds.), Marcel Dekker, Inc., New York,N.Y., 1988, volume 1, p. 199). Surfactants are typically amphiphilic andcomprise a hydrophilic and a hydrophobic portion. The ratio of thehydrophilic to the hydrophobic nature of the surfactant has been termedthe hydrophile/lipophile balance (HLB) and is a valuable tool incategorizing and selecting surfactants in the preparation offormulations. Surfactants may be classified into different classes basedon the nature of the hydrophilic group: nonionic, anionic, cationic andamphoteric (Rieger, in Pharmaceutical Dosage Forms, Lieberman, Riegerand Banker (Eds.), 1988, Marcel Dekker, Inc., New York, N.Y., volume 1,p. 285).

Naturally occurring emulsifiers used in emulsion formulations includelanolin, beeswax, phosphatides, lecithin and acacia. Absorption basespossess hydrophilic properties such that they can soak up water to formw/o emulsions yet retain their semisolid consistencies, such asanhydrous lanolin and hydrophilic petrolatum. Finely divided solids havealso been used as good emulsifiers especially in combination withsurfactants and in viscous preparations. These include polar inorganicsolids, such as heavy metal hydroxides, nonswelling clays such asbentonite, attapulgite, hectorite, kaolin, montmorillonite, colloidalaluminum silicate and colloidal magnesium aluminum silicate, pigmentsand nonpolar solids such as carbon or glyceryl tristearate.

A large variety of non-emulsifying materials are also included inemulsion formulations and contribute to the properties of emulsions.These include fats, oils, waxes, fatty acids, fatty alcohols, fattyesters, humectants, hydrophilic colloids, preservatives and antioxidants(Block, in Pharmaceutical Dosage Forms, Lieberman, Rieger and Banker(Eds.), 1988, Marcel Dekker, Inc., New York, N.Y., volume 1, p. 335;Idson, in Pharmaceutical Dosage Forms, Lieberman, Rieger and Banker(Eds.), 1988, Marcel Dekker, Inc., New York, N.Y., volume 1, p. 199).

Hydrophilic colloids or hydrocolloids include naturally occurring gumsand synthetic polymers such as polysaccharides (for example, acacia,agar, alginic acid, carrageenan, guar gum, karaya gum, and tragacanth),cellulose derivatives (for example, carboxymethylcellulose andcarboxypropylcellulose), and synthetic polymers (for example, carbomers,cellulose ethers, and carboxyvinyl polymers). These disperse or swell inwater to form colloidal solutions that stabilize emulsions by formingstrong interfacial films around the dispersed-phase droplets and byincreasing the viscosity of the external phase.

Since emulsions often contain a number of ingredients such ascarbohydrates, proteins, sterols and phosphatides that may readilysupport the growth of microbes, these formulations often incorporatepreservatives. Commonly used preservatives included in emulsionformulations include methyl paraben, propyl paraben, quaternary ammoniumsalts, benzalkonium chloride, esters of p-hydroxybenzoic acid, and boricacid. Antioxidants are also commonly added to emulsion formulations toprevent deterioration of the formulation. Antioxidants used may be freeradical scavengers such as tocopherols, alkyl gallates, butylatedhydroxyanisole, butylated hydroxytoluene, or reducing agents such asascorbic acid and sodium metabisulfite, and antioxidant synergists suchas citric acid, tartaric acid, and lecithin.

The application of emulsion formulations via dermatological, oral andparenteral routes and methods for their manufacture have been reviewedin the literature (Idson, in Pharmaceutical Dosage Forms, Lieberman,Rieger and Banker (Eds.), 1988, Marcel Dekker, Inc., New York, N.Y.,volume 1, p. 199). Emulsion formulations for oral delivery have beenvery widely used because of ease of formulation, as well as efficacyfrom an absorption and bioavailability standpoint (Rosoff, inPharmaceutical Dosage Forms, Lieberman, Rieger and Banker (Eds.), 1988,Marcel Dekker, Inc., New York, N.Y., volume 1, p. 245; Idson, inPharmaceutical Dosage Forms, Lieberman, Rieger and Banker (Eds.), 1988,Marcel Dekker, Inc., New York, N.Y., volume 1, p. 199). Mineral-oil baselaxatives, oil-soluble vitamins and high fat nutritive preparations areamong the materials that have commonly been administered orally as o/wemulsions.

In one embodiment of the present invention, the compositions of dsRNAsand nucleic acids are formulated as microemulsions. A microemulsion maybe defined as a system of water, oil and amphiphile which is a singleoptically isotropic and thermodynamically stable liquid solution(Rosoff, in Pharmaceutical Dosage Forms, Lieberman, Rieger and Banker(Eds.), 1988, Marcel Dekker, Inc., New York, N.Y., volume 1, p. 245).Typically microemulsions are systems that are prepared by firstdispersing an oil in an aqueous surfactant solution and then adding asufficient amount of a fourth component, generally an intermediatechain-length alcohol to form a transparent system. Therefore,microemulsions have also been described as thermodynamically stable,isotropically clear dispersions of two immiscible liquids that arestabilized by interfacial films of surface-active molecules (Leung andShah, in: Controlled Release of Drugs: Polymers and Aggregate Systems,Rosoff, M., Ed., 1989, VCH Publishers, New York, pages 185-215).Microemulsions commonly are prepared via a combination of three to fivecomponents that include oil, water, surfactant, cosurfactant andelectrolyte. Whether the microemulsion is of the water-in-oil (w/o) oran oil-in-water (o/w) type is dependent on the properties of the oil andsurfactant used and on the structure and geometric packing of the polarheads and hydrocarbon tails of the surfactant molecules (Schott, inRemington's Pharmaceutical Sciences, Mack Publishing Co., Easton, Pa.,1985, p. 271).

The phenomenological approach utilizing phase diagrams has beenextensively studied and has yielded a comprehensive knowledge, to oneskilled in the art, of how to formulate microemulsions (Rosoff, inPharmaceutical Dosage Forms, Lieberman, Rieger and Banker (Eds.), 1988,Marcel Dekker, Inc., New York, N.Y., volume 1, p. 245; Block, inPharmaceutical Dosage Forms, Lieberman, Rieger and Banker (Eds.), 1988,Marcel Dekker, Inc., New York, N.Y., volume 1, p. 335). Compared toconventional emulsions, microemulsions offer the advantage ofsolubilizing water-insoluble drugs in a formulation of thermodynamicallystable droplets that are formed spontaneously.

Surfactants used in the preparation of microemulsions include, but arenot limited to, ionic surfactants, non-ionic surfactants, Brij 96,polyoxyethylene oleyl ethers, polyglycerol fatty acid esters,tetraglycerol monolaurate (ML310), tetraglycerol monooleate (MO310),hexaglycerol monooleate (PO310), hexaglycerol pentaoleate (PO500),decaglycerol monocaprate (MCA750), decaglycerol monooleate (MO750),decaglycerol sequioleate (SO750), decaglycerol decaoleate (DAO750),alone or in combination with cosurfactants. The cosurfactant, usually ashort-chain alcohol such as ethanol, 1-propanol, and 1-butanol, servesto increase the interfacial fluidity by penetrating into the surfactantfilm and consequently creating a disordered film because of the voidspace generated among surfactant molecules. Microemulsions may, however,be prepared without the use of cosurfactants and alcohol-freeself-emulsifying microemulsion systems are known in the art. The aqueousphase may typically be, but is not limited to, water, an aqueoussolution of the drug, glycerol, PEG300, PEG400, polyglycerols, propyleneglycols, and derivatives of ethylene glycol. The oil phase may include,but is not limited to, materials such as Captex 300, Captex 355, CapmulMCM, fatty acid esters, medium chain (C8-C12) mono, di, andtri-glycerides, polyoxyethylated glyceryl fatty acid esters, fattyalcohols, polyglycolized glycerides, saturated polyglycolized C8-C10glycerides, vegetable oils and silicone oil.

Microemulsions are particularly of interest from the standpoint of drugsolubilization and the enhanced absorption of drugs. Lipid basedmicroemulsions (both o/w and w/o) have been proposed to enhance the oralbioavailability of drugs, including peptides (Constantinides et al.,Pharmaceutical Research, 1994, 11, 1385-1390; Ritschel, Meth. Find. Exp.Clin. Pharmacol., 1993, 13, 205). Microemulsions afford advantages ofimproved drug solubilization, protection of drug from enzymatichydrolysis, possible enhancement of drug absorption due tosurfactant-induced alterations in membrane fluidity and permeability,ease of preparation, ease of oral administration over solid dosageforms, improved clinical potency, and decreased toxicity (Constantinideset al., Pharmaceutical Research, 1994, 11, 1385; Ho et al., J. Pharm.Sci., 1996, 85, 138-143). Often microemulsions may form spontaneouslywhen their components are brought together at ambient temperature. Thismay be particularly advantageous when formulating thermolabile drugs,peptides or dsRNAs. Microemulsions have also been effective in thetransdermal delivery of active components in both cosmetic andpharmaceutical applications. It is expected that the microemulsioncompositions and formulations of the present invention will facilitatethe increased systemic absorption of dsRNAs and nucleic acids from thegastrointestinal tract, as well as improve the local cellular uptake ofdsRNAs and nucleic acids.

Microemulsions of the present invention may also contain additionalcomponents and additives such as sorbitan monostearate (Grill 3),Labrasol, and penetration enhancers to improve the properties of theformulation and to enhance the absorption of the dsRNAs and nucleicacids of the present invention. Penetration enhancers used in themicroemulsions of the present invention may be classified as belongingto one of five broad categories—surfactants, fatty acids, bile salts,chelating agents, and non-chelating non-surfactants (Lee et al.,Critical Reviews in Therapeutic Drug Carrier Systems, 1991, p. 92). Eachof these classes has been discussed above.

Penetration Enhancers

In one embodiment, the present invention employs various penetrationenhancers to effect the efficient delivery of nucleic acids,particularly dsRNAs, to the skin of animals. Most drugs are present insolution in both ionized and nonionized forms. However, usually onlylipid soluble or lipophilic drugs readily cross cell membranes. It hasbeen discovered that even non-lipophilic drugs may cross cell membranesif the membrane to be crossed is treated with a penetration enhancer. Inaddition to aiding the diffusion of non-lipophilic drugs across cellmembranes, penetration enhancers also enhance the permeability oflipophilic drugs.

Penetration enhancers may be classified as belonging to one of fivebroad categories, i.e., surfactants, fatty acids, bile salts, chelatingagents, and non-chelating non-surfactants (Lee et al., Critical Reviewsin Therapeutic Drug Carrier Systems, 1991, p. 92). Each of the abovementioned classes of penetration enhancers are described below ingreater detail.

Surfactants: In connection with the present invention, surfactants (or“surface-active agents”) are chemical entities which, when dissolved inan aqueous solution, reduce the surface tension of the solution or theinterfacial tension between the aqueous solution and another liquid,with the result that absorption of dsRNAs through the mucosa isenhanced. In addition to bile salts and fatty acids, these penetrationenhancers include, for example, sodium lauryl sulfate,polyoxyethylene-9-lauryl ether and polyoxyethylene-20-cetyl ether) (Leeet al., Critical Reviews in Therapeutic Drug Carrier Systems, 1991, p.92); and perfluorochemical emulsions, such as FC-43. Takahashi et al.,J. Pharm. Pharmacol., 1988, 40, 252).

Fatty acids: Various fatty acids and their derivatives which act aspenetration enhancers include, for example, oleic acid, lauric acid,capric acid (n-decanoic acid), myristic acid, palmitic acid, stearicacid, linoleic acid, linolenic acid, dicaprate, tricaprate, monoolein(1-monooleoyl-rac-glycerol), dilaurin, caprylic acid, arachidonic acid,glycerol 1-monocaprate, 1-dodecylazacycloheptan-2-one, acylcarnitines,acylcholines, C.sub.1-10 alkyl esters thereof (e.g., methyl, isopropyland t-butyl), and mono- and di-glycerides thereof (i.e., oleate,laurate, caprate, myristate, palmitate, stearate, linoleate, etc.) (Leeet al., Critical Reviews in Therapeutic Drug Carrier Systems, 1991, p.92; Muranishi, Critical Reviews in Therapeutic Drug Carrier Systems,1990, 7, 1-33; El Hariri et al., J. Pharm. Pharmacol., 1992, 44,651-654).

Bile salts: The physiological role of bile includes the facilitation ofdispersion and absorption of lipids and fat-soluble vitamins (Brunton,Chapter 38 in: Goodman & Gilman's The Pharmacological Basis ofTherapeutics, 9th Ed., Hardman et al. Eds., McGraw-Hill, New York, 1996,pp. 934-935). Various natural bile salts, and their syntheticderivatives, act as penetration enhancers. Thus the term “bile salts”includes any of the naturally occurring components of bile as well asany of their synthetic derivatives. Suitable bile salts include, forexample, cholic acid (or its pharmaceutically acceptable sodium salt,sodium cholate), dehydrocholic acid (sodium dehydrocholate), deoxycholicacid (sodium deoxycholate), glucholic acid (sodium glucholate),glycholic acid (sodium glycocholate), glycodeoxycholic acid (sodiumglycodeoxycholate), taurocholic acid (sodium taurocholate),taurodeoxycholic acid (sodium taurodeoxycholate), chenodeoxycholic acid(sodium chenodeoxycholate), ursodeoxycholic acid (UDCA), sodiumtauro-24,25-dihydro-fusidate (STDHF), sodium glycodihydrofusidate andpolyoxyethylene-9-lauryl ether (POE) (Lee et al., Critical Reviews inTherapeutic Drug Carrier Systems, 1991, page 92; Swinyard, Chapter 39In: Remington's Pharmaceutical Sciences, 18th Ed., Gennaro, ed., MackPublishing Co., Easton, Pa., 1990, pages 782-783; Muranishi, CriticalReviews in Therapeutic Drug Carrier Systems, 1990, 7, 1-33; Yamamoto etal., J. Pharm. Exp. Ther., 1992, 263, 25; Yamashita et al., J. Pharm.Sci., 1990, 79, 579-583).

Chelating Agents: Chelating agents, as used in connection with thepresent invention, can be defined as compounds that remove metallic ionsfrom solution by forming complexes therewith, with the result thatabsorption of dsRNAs through the mucosa is enhanced. With regards totheir use as penetration enhancers in the present invention, chelatingagents have the added advantage of also serving as DNase inhibitors, asmost characterized DNA nucleases require a divalent metal ion forcatalysis and are thus inhibited by chelating agents (Jarrett, J.Chromatogr., 1993, 618, 315-339). Suitable chelating agents include butare not limited to disodium ethylenediaminetetraacetate (EDTA), citricacid, salicylates (e.g., sodium salicylate, 5-methoxysalicylate andhomovanilate), N-acyl derivatives of collagen, laureth-9 and N-aminoacyl derivatives of beta-diketones (enamines)(Lee et al., CriticalReviews in Therapeutic Drug Carrier Systems, 1991, page 92; Muranishi,Critical Reviews in Therapeutic Drug Carrier Systems, 1990, 7, 1-33;Buur et al., J. Control Rel., 1990, 14, 43-51).

Non-chelating non-surfactants: As used herein, non-chelatingnon-surfactant penetration enhancing compounds can be defined ascompounds that demonstrate insignificant activity as chelating agents oras surfactants but that nonetheless enhance absorption of dsRNAs throughthe alimentary mucosa (Muranishi, Critical Reviews in Therapeutic DrugCarrier Systems, 1990, 7, 1-33). This class of penetration enhancersinclude, for example, unsaturated cyclic ureas, 1-alkyl- and1-alkenylazacyclo-alkanone derivatives (Lee et al., Critical Reviews inTherapeutic Drug Carrier Systems, 1991, page 92); and non-steroidalanti-inflammatory agents such as diclofenac sodium, indomethacin andphenylbutazone (Yamashita et al., J. Pharm. Pharmacol., 1987, 39,621-626).

Carriers

Certain compositions of the present invention also incorporate carriercompounds in the formulation. As used herein, “carrier compound” or“carrier” can refer to a nucleic acid, or analog thereof, which is inert(i.e., does not possess biological activity per se) but is recognized asa nucleic acid by in vivo processes that reduce the bioavailability of anucleic acid having biological activity by, for example, degrading thebiologically active nucleic acid or promoting its removal fromcirculation. The coadministration of a nucleic acid and a carriercompound, typically with an excess of the latter substance, can resultin a substantial reduction of the amount of nucleic acid recovered inthe liver, kidney or other extracirculatory reservoirs, presumably dueto competition between the carrier compound and the nucleic acid for acommon receptor. For example, the recovery of a partiallyphosphorothioate dsRNA in hepatic tissue can be reduced when it iscoadministered with polyinosinic acid, dextran sulfate, polycytidic acidor 4-acetamido-4′ isothiocyano-stilbene-2,2′-disulfonic acid (Miyao etal., DsRNA Res. Dev., 1995, 5, 115-121; Takakura et al., DsRNA & Nucl.Acid Drug Dev., 1996, 6, 177-183.

Excipients

In contrast to a carrier compound, a “pharmaceutical carrier” or“excipient” is a pharmaceutically acceptable solvent, suspending agentor any other pharmacologically inert vehicle for delivering one or morenucleic acids to an animal. The excipient may be liquid or solid and isselected, with the planned manner of administration in mind, so as toprovide for the desired bulk, consistency, etc., when combined with anucleic acid and the other components of a given pharmaceuticalcomposition. Typical pharmaceutical carriers include, but are notlimited to, binding agents (e.g., pregelatinized maize starch,polyvinylpyrrolidone or hydroxypropyl methylcellulose, etc.); fillers(e.g., lactose and other sugars, microcrystalline cellulose, pectin,gelatin, calcium sulfate, ethyl cellulose, polyacrylates or calciumhydrogen phosphate, etc.); lubricants (e.g., magnesium stearate, talc,silica, colloidal silicon dioxide, stearic acid, metallic stearates,hydrogenated vegetable oils, corn starch, polyethylene glycols, sodiumbenzoate, sodium acetate, etc.); disintegrants (e.g., starch, sodiumstarch glycolate, etc.); and wetting agents (e.g., sodium laurylsulphate, etc).

Pharmaceutically acceptable organic or inorganic excipients suitable fornon-parenteral administration which do not deleteriously react withnucleic acids can also be used to formulate the compositions of thepresent invention. Suitable pharmaceutically acceptable carriersinclude, but are not limited to, water, salt solutions, alcohols,polyethylene glycols, gelatin, lactose, amylose, magnesium stearate,talc, silicic acid, viscous paraffin, hydroxymethylcellulose,polyvinylpyrrolidone and the like.

Formulations for topical administration of nucleic acids may includesterile and non-sterile aqueous solutions, non-aqueous solutions incommon solvents such as alcohols, or solutions of the nucleic acids inliquid or solid oil bases. The solutions may also contain buffers,diluents and other suitable additives. Pharmaceutically acceptableorganic or inorganic excipients suitable for non-parenteraladministration which do not deleteriously react with nucleic acids canbe used.

Suitable pharmaceutically acceptable excipients include, but are notlimited to, water, salt solutions, alcohol, polyethylene glycols,gelatin, lactose, amylose, magnesium stearate, talc, silicic acid,viscous paraffin, hydroxymethylcellulose, polyvinylpyrrolidone and thelike.

Other Components

The compositions of the present invention may additionally contain otheradjunct components conventionally found in pharmaceutical compositions,at their art-established usage levels. Thus, for example, thecompositions may contain additional, compatible, pharmaceutically-activematerials such as, for example, antipruritics, astringents, localanesthetics or anti-inflammatory agents, or may contain additionalmaterials useful in physically formulating various dosage forms of thecompositions of the present invention, such as dyes, flavoring agents,preservatives, antioxidants, opacifiers, thickening agents andstabilizers. However, such materials, when added, should not undulyinterfere with the biological activities of the components of thecompositions of the present invention. The formulations can besterilized and, if desired, mixed with auxiliary agents, e.g.,lubricants, preservatives, stabilizers, wetting agents, emulsifiers,salts for influencing osmotic pressure, buffers, colorings, flavoringsand/or aromatic substances and the like which do not deleteriouslyinteract with the nucleic acid(s) of the formulation.

Aqueous suspensions may contain substances which increase the viscosityof the suspension including, for example, sodium carboxymethylcellulose,sorbitol and/or dextran. The suspension may also contain stabilizers.

In some embodiments, pharmaceutical compositions featured in theinvention include (a) one or more dsRNA compounds and (b) one or moreanti-cytokine biologic agents which function by a non-RNAi mechanism.Examples of such biologics include, biologics that target IL1β (e.g.,anakinra), IL6 (tocilizumab), or TNF (etanercept, infliximab, adlimumab,or certolizumab).

Toxicity and therapeutic efficacy of such compounds can be determined bystandard pharmaceutical procedures in cell cultures or experimentalanimals, e.g., for determining the LD50 (the dose lethal to 50% of thepopulation) and the ED50 (the dose therapeutically effective in 50% ofthe population). The dose ratio between toxic and therapeutic effects isthe therapeutic index and it can be expressed as the ratio LD50/ED50.Compounds that exhibit high therapeutic indices are preferred.

The data obtained from cell culture assays and animal studies can beused in formulating a range of dosage for use in humans. The dosage ofcompositions featured in the invention lies generally within a range ofcirculating concentrations that include the ED50 with little or notoxicity. The dosage may vary within this range depending upon thedosage form employed and the route of administration utilized. For anycompound used in the methods featured in the invention, thetherapeutically effective dose can be estimated initially from cellculture assays. A dose may be formulated in animal models to achieve acirculating plasma concentration range of the compound or, whenappropriate, of the polypeptide product of a target sequence (e.g.,achieving a decreased concentration of the polypeptide) that includesthe IC50 (i.e., the concentration of the test compound which achieves ahalf-maximal inhibition of symptoms) as determined in cell culture. Suchinformation can be used to more accurately determine useful doses inhumans. Levels in plasma may be measured, for example, by highperformance liquid chromatography.

In addition to their administration, as discussed above, the dsRNAsfeatured in the invention can be administered in combination with otherknown agents effective in treatment of pathological processes mediatedby TTR expression. In any event, the administering physician can adjustthe amount and timing of dsRNA administration on the basis of resultsobserved using standard measures of efficacy known in the art ordescribed herein.

Methods for Treating Diseases Caused by Expression of a TTR Gene

The invention relates in particular to the use of a dsRNA targeting TTRand compositions containing at least one such dsRNA for the treatment ofa TTR-mediated disorder or disease. For example, a dsRNA targeting a TTRgene can be useful for the treatment of a TTR amyloidosis, such asfamilial amyloidotic polyneuropathy (FAP), familial amyloidoticcardiomyopathy (FAC), leptomeningeal/CNS amyloidosis, amyloidosis VIIform (also known as leptomeningeal or meningocerebrovascularamyloidosis), hyperthyroxinemia, and cardiac amyloidosis (also calledsenile systemic amyloidosis (SSA) and senile cardiac amyloidosis (SCA)).

FIG. 15 illustrates symptoms and mutations in TTR associated withfamilial amyloidotic neuropathy, familial amyloidotic cardiomyopathy andCNS amyloidosis. The invention includes compositions and methods fortreatment of these diseases and symptoms, and directed to these mutantversions of TTR.

A dsRNA targeting a TTR gene is also used for treatment of symptoms anddisorders, such as TTR amyloidosis. Symptoms associated with suchamyloidosis include, e.g., seizures, dementia, myelopathy,polyneuropathy, carpal tunnel syndrome, autonomic insufficiency,cardiomyopathy, gastrointestinal dysfunction (e.g., gastric ulcers,diarrhea, constipation, malabsorption), weight loss, hepatomegaly,lymphadenopathy, goiter, vitreous opacities, renal insufficiency(including proteinuria and kidney failure), nephropathy, cranial nervedysfunction, corneal lattice dystrophy, and congestive heart failurewith generalized weakness and difficulties breathing from fluidretention.

Owing to the inhibitory effects on TTR expression, a compositionaccording to the invention or a pharmaceutical composition preparedtherefrom can enhance the quality of life.

The invention further relates to the use of a dsRNA or a pharmaceuticalcomposition thereof, e.g., for treating a TTR amyloidosis, incombination with other pharmaceuticals and/or other therapeutic methods,e.g., with known pharmaceuticals and/or known therapeutic methods, suchas, for example, those which are currently employed for treating thesedisorders. In one example, a dsRNA targeting TTR can be administered incombination with a liver transplant. In other examples, a dsRNAtargeting TTR can be administered in combination with a pharmaceuticalor therapeutic method for treating a symptom of a TTR disease, such asdiuretics, ACE (angiotensin converting enzyme) inhibitors, angiotensinreceptor blockers (ARBs), or dialysis, e.g., for management of renalfunction.

The dsRNA and an additional therapeutic agent can be administered in thesame combination, e.g., parenterally, or the additional therapeuticagent can be administered as part of a separate composition or byanother method described herein.

The invention features a method of administering a dsRNA targeting TTRto a patient having a disease or disorder mediated by TTR expression,such as a TTR amyloidosis, e.g., FAP. Administration of the dsRNA canstabilize and improve peripheral neurological function, for example, ina patient with FAP. Patients can be administered a therapeutic amount ofdsRNA, such as 0.1 mg/kg, 0.2 mg/kg, 0.5 mg/kg, 1.0 mg/kg, 1.5 mg/kg,2.0 mg/kg, or 2.5 mg/kg dsRNA. The dsRNA can be administered byintravenous infusion over a period of time, such as over a 5 minute, 10minute, 15 minute, 20 minute, 25 minute, 60 minute, 120 minute or 180minute period. The administration is repeated, for example, on a regularbasis, such as biweekly (i.e., every two weeks) for one month, twomonths, three months, four months or longer. After an initial treatmentregimen, the treatments can be administered on a less frequent basis.For example, after administration biweekly for three months,administration can be repeated once per month, for six months or a yearor longer. Administration of the dsRNA can reduce TTR levels in theblood or urine of the patient by at least 20%, 25%, 30%, 40%, 50%, 60%,70%, 80% or 90% or more.

Before administration of a full dose of the dsRNA, patients can beadministered a smaller dose, such as a dose that is 5% of the full dose,and monitored for adverse effects, such as an allergic reaction or achange in liver function. For example, in patients monitored for changesin liver function, a low incidence of LFT (Liver Function Test) change(e.g., a 10-20% incidence of LFT) is acceptable (e.g., a reversible,3-fold increase in ALT (alanine aminotransferase) and/or AST (aspartateaminotransferase) levels).

Many TTR-associated diseases and disorders are hereditary. Therefore, apatient in need of a TTR dsRNA can be identified by taking a familyhistory. A healthcare provider, such as a doctor, nurse, or familymember, can take a family history before prescribing or administering aTTR dsRNA. A DNA test may also be performed on the patient to identify amutation in the TTR gene, before a TTR dsRNA is administered to thepatient.

The patient may have a biopsy performed before receiving a TTR dsRNA.The biopsy can be, for example, on a tissue, such as the gastric mucosa,peripheral nerve, skin, abdominal fat, liver, or kidney, and the biopsymay reveal amyloid plaques, which are indicative of a TTR-mediateddisorder. Upon the identification of amyloid plaques, the patient isadministered a TTR dsRNA.

Methods for Inhibiting Expression of a TTR Gene

In yet another aspect, the invention provides a method for inhibitingthe expression of a TTR gene in a mammal. The method includesadministering a composition featured in the invention to the mammal suchthat expression of the target TTR gene is silenced.

When the organism to be treated is a mammal such as a human, thecomposition may be administered by any means known in the art including,but not limited to oral or parenteral routes, including intracranial(e.g., intraventricular, intraparenchymal and intrathecal), intravenous,intramuscular, subcutaneous, transdermal, airway (aerosol), nasal,rectal, and topical (including buccal and sublingual) administration. Incertain embodiments, the compositions are administered by intravenousinfusion or injection.

Unless otherwise defined, all technical and scientific terms used hereinhave the same meaning as commonly understood by one of ordinary skill inthe art to which this invention belongs. Although methods and materialssimilar or equivalent to those described herein can be used in thepractice or testing of the dsRNAs and methods featured in the invention,suitable methods and materials are described below. All publications,patent applications, patents, and other references mentioned herein areincorporated by reference in their entirety. In case of conflict, thepresent specification, including definitions, will control. In addition,the materials, methods, and examples are illustrative only and notintended to be limiting.

EXAMPLES Example 1 dsRNA Synthesis

Source of Reagents

Where the source of a reagent is not specifically given herein, suchreagent may be obtained from any supplier of reagents for molecularbiology at a quality/purity standard for application in molecularbiology.

siRNA Synthesis

Single-stranded RNAs were produced by solid phase synthesis on a scaleof 1 μmole using an Expedite 8909 synthesizer (Applied Biosystems,Applera Deutschland GmbH, Darmstadt, Germany) and controlled pore glass(CPG, 500 Å, Proligo Biochemie GmbH, Hamburg, Germany) as solid support.RNA and RNA containing 2′-O-methyl nucleotides were generated by solidphase synthesis employing the corresponding phosphoramidites and2′-β-methyl phosphoramidites, respectively (Proligo Biochemie GmbH,Hamburg, Germany). These building blocks were incorporated at selectedsites within the sequence of the oligoribonucleotide chain usingstandard nucleoside phosphoramidite chemistry such as described inCurrent protocols in nucleic acid chemistry, Beaucage, S. L. et al.(Edrs.), John Wiley & Sons, Inc., New York, N.Y., USA. Phosphorothioatelinkages were introduced by replacement of the iodine oxidizer solutionwith a solution of the Beaucage reagent (Chruachem Ltd, Glasgow, UK) inacetonitrile (1%). Further ancillary reagents were obtained fromMallinckrodt Baker (Griesheim, Germany).

Deprotection and purification of the crude oligoribonucleotides by anionexchange HPLC were carried out according to established procedures.Yields and concentrations were determined by UV absorption of a solutionof the respective RNA at a wavelength of 260 nm using a spectralphotometer (DU 640B, Beckman Coulter GmbH, UnterschleiBheim, Germany).Double stranded RNA was generated by mixing an equimolar solution ofcomplementary strands in annealing buffer (20 mM sodium phosphate, pH6.8; 100 mM sodium chloride), heated in a water bath at 85-90° C. for 3minutes and cooled to room temperature over a period of 3-4 hours. Theannealed RNA solution was stored at −20° C. until use.

For the synthesis of 3′-cholesterol-conjugated siRNAs (herein referredto as -Chol-3′), an appropriately modified solid support was used forRNA synthesis. The modified solid support was prepared as follows:

Diethyl-2-azabutane-1,4-dicarboxylate AA

A 4.7 M aqueous solution of sodium hydroxide (50 mL) was added into astirred, ice-cooled solution of ethyl glycinate hydrochloride (32.19 g,0.23 mole) in water (50 mL). Then, ethyl acrylate (23.1 g, 0.23 mole)was added and the mixture was stirred at room temperature untilcompletion of the reaction was ascertained by TLC. After 19 h thesolution was partitioned with dichloromethane (3×100 mL). The organiclayer was dried with anhydrous sodium sulfate, filtered and evaporated.The residue was distilled to afford AA (28.8 g, 61%).

3-{Ethoxycarbonylmethyl-[6-(9H-fluoren-9-ylmethoxycarbonyl-amino)-hexanoyl]-amino}-propionicacid ethyl ester AB

Fmoc-6-amino-hexanoic acid (9.12 g, 25.83 mmol) was dissolved indichloromethane (50 mL) and cooled with ice. Diisopropylcarbodiimde(3.25 g, 3.99 mL, 25.83 mmol) was added to the solution at 0° C. It wasthen followed by the addition of Diethyl-azabutane-1,4-dicarboxylate (5g, 24.6 mmol) and dimethylamino pyridine (0.305 g, 2.5 mmol). Thesolution was brought to room temperature and stirred further for 6 h.Completion of the reaction was ascertained by TLC. The reaction mixturewas concentrated under vacuum and ethyl acetate was added to precipitatediisopropyl urea. The suspension was filtered. The filtrate was washedwith 5% aqueous hydrochloric acid, 5% sodium bicarbonate and water. Thecombined organic layer was dried over sodium sulfate and concentrated togive the crude product which was purified by column chromatography (50%EtOAC/Hexanes) to yield 11.87 g (88%) of AB.

3-[(6-Amino-hexanoyl)-ethoxycarbonylmethyl-amino]-propionic acid ethylester AC

3-{Ethoxycarbonylmethyl-[6-(9H-fluoren-9-ylmethoxycarbonylamino)-hexanoyl]-amino}-propionicacid ethyl ester AB (11.5 g, 21.3 mmol) was dissolved in 20% piperidinein dimethylformamide at 0° C. The solution was continued stirring for 1h. The reaction mixture was concentrated under vacuum, water was addedto the residue, and the product was extracted with ethyl acetate. Thecrude product was purified by conversion into its hydrochloride salt.

3-({6-[17-(1,5-Dimethyl-hexyl)-10,13-dimethyl-2,3,4,7,8,9,10,11,12,13,14,15,16,17-tetradecahydro-1H-cyclopenta[a]phenanthren-3-yloxycarbonylamino]-hexanoyl}ethoxycarbonylmethyl-amino)-propionicacid ethyl ester AD

The hydrochloride salt of3-[(6-Amino-hexanoyl)-ethoxycarbonylmethyl-amino]-propionic acid ethylester AC (4.7 g, 14.8 mmol) was taken up in dichloromethane. Thesuspension was cooled to 0° C. on ice. To the suspensiondiisopropylethylamine (3.87 g, 5.2 mL, 30 mmol) was added. To theresulting solution cholesteryl chloroformate (6.675 g, 14.8 mmol) wasadded. The reaction mixture was stirred overnight. The reaction mixturewas diluted with dichloromethane and washed with 10% hydrochloric acid.The product was purified by flash chromatography (10.3 g, 92%).

1-{6-[17-(1,5-Dimethyl-hexyl)-10,13-dimethyl-2,3,4,7,8,9,10,11,12,13,14,15,16,17-tetradecahydro-1H-cyclopenta[a]phenanthren-3-yloxycarbonylamino]-hexanoyl}-4-oxo-pyrrolidine-3-carboxylicacid ethyl ester AE

Potassium t-butoxide (1.1 g, 9.8 mmol) was slurried in 30 mL of drytoluene. The mixture was cooled to 0° C. on ice and 5 g (6.6 mmol) ofdiester AD was added slowly with stirring within 20 mins. Thetemperature was kept below 5° C. during the addition. The stirring wascontinued for 30 mins at 0° C. and 1 mL of glacial acetic acid wasadded, immediately followed by 4 g of NaH₂PO₄.H₂O in 40 mL of water Theresultant mixture was extracted twice with 100 mL of dichloromethaneeach and the combined organic extracts were washed twice with 10 mL ofphosphate buffer each, dried, and evaporated to dryness. The residue wasdissolved in 60 mL of toluene, cooled to 0° C. and extracted with three50 mL portions of cold pH 9.5 carbonate buffer. The aqueous extractswere adjusted to pH 3 with phosphoric acid, and extracted with five 40mL portions of chloroform which were combined, dried and evaporated todryness. The residue was purified by column chromatography using 25%ethylacetate/hexane to afford 1.9 g of b-ketoester (39%).

[6-(3-Hydroxy-4-hydroxymethyl-pyrrolidin-1-yl)-6-oxo-hexyl]-carbamicacid 17-(1,5-dimethyl-hexyl)-10,13-dimethyl-2,3,4,7,8,9,10,11,12,13,14,15,16,17-tetradecahydro-1H-cyclopenta[a]phenanthren-3-ylester AF

Methanol (2 mL) was added dropwise over a period of 1 h to a refluxingmixture of b-ketoester AE (1.5 g, 2.2 mmol) and sodium borohydride(0.226 g, 6 mmol) in tetrahydrofuran (10 mL). Stirring was continued atreflux temperature for 1 h. After cooling to room temperature, 1 N HCl(12.5 mL) was added, the mixture was extracted with ethylacetate (3×40mL). The combined ethylacetate layer was dried over anhydrous sodiumsulfate and concentrated under vacuum to yield the product which waspurified by column chromatography (10% MeOH/CHCl₃) (89%).

(6-{3-[Bis-(4-methoxy-phenyl)-phenyl-methoxymethyl]-4-hydroxy-pyrrolidin-1-yl}-6-oxo-hexyl)-carbamicacid17-(1,5-dimethyl-hexyl)-10,13-dimethyl-2,3,4,7,8,9,10,11,12,13,14,15,16,17-tetradecahydro-1H-cyclopenta[a]phenanthren-3-ylester AG

Diol AF (1.25 gm 1.994 mmol) was dried by evaporating with pyridine (2×5mL) in vacuo. Anhydrous pyridine (10 mL) and4,4′-dimethoxytritylchloride (0.724 g, 2.13 mmol) were added withstirring. The reaction was carried out at room temperature overnight.The reaction was quenched by the addition of methanol. The reactionmixture was concentrated under vacuum and to the residue dichloromethane(50 mL) was added. The organic layer was washed with 1M aqueous sodiumbicarbonate. The organic layer was dried over anhydrous sodium sulfate,filtered and concentrated. The residual pyridine was removed byevaporating with toluene. The crude product was purified by columnchromatography (2% MeOH/Chloroform, Rf=0.5 in 5% MeOH/CHCl₃) (1.75 g,95%).

Succinic acidmono-(4-[bis-(4-methoxy-phenyl)-phenyl-methoxymethyl]-1-{6-[17-(1,5-dimethyl-hexyl)-10,13-dimethyl2,3,4,7,8,9,10,11,12,13,14,15,16,17-tetradecahydro-1Hcyclopenta[a]phenanthren-3-yloxycarbonylamino]-hexanoyl}-pyrrolidin-3-yl)esterAH

Compound AG (1.0 g, 1.05 mmol) was mixed with succinic anhydride (0.150g, 1.5 mmol) and DMAP (0.073 g, 0.6 mmol) and dried in a vacuum at 40°C. overnight. The mixture was dissolved in anhydrous dichloroethane (3mL), triethylamine (0.318 g, 0.440 mL, 3.15 mmol) was added and thesolution was stirred at room temperature under argon atmosphere for 16h. It was then diluted with dichloromethane (40 mL) and washed with icecold aqueous citric acid (5 wt %, 30 mL) and water (2×20 mL). Theorganic phase was dried over anhydrous sodium sulfate and concentratedto dryness. The residue was used as such for the next step.

Cholesterol Derivatised CPG AI

Succinate AH (0.254 g, 0.242 mmol) was dissolved in a mixture ofdichloromethane/acetonitrile (3:2, 3 mL). To that solution DMAP (0.0296g, 0.242 mmol) in acetonitrile (1.25 mL),2,2′-Dithio-bis(5-nitropyridine) (0.075 g, 0.242 mmol) inacetonitrile/dichloroethane (3:1, 1.25 mL) were added successively. Tothe resulting solution triphenylphosphine (0.064 g, 0.242 mmol) inacetonitrile (0.6 ml) was added. The reaction mixture turned brightorange in color. The solution was agitated briefly using a wrist-actionshaker (5 mins). Long chain alkyl amine-CPG (LCAA-CPG) (1.5 g, 61 mM)was added. The suspension was agitated for 2 h. The CPG was filteredthrough a sintered funnel and washed with acetonitrile, dichloromethaneand ether successively. Unreacted amino groups were masked using aceticanhydride/pyridine. The achieved loading of the CPG was measured bytaking UV measurement (37 mM/g).

The synthesis of siRNAs bearing a 5′-12-dodecanoic acid bisdecylamidegroup (herein referred to as “5′-C32-”) or a 5′-cholesteryl derivativegroup (herein referred to as “5′-Chol-”) was performed as described inWO 2004/065601, except that, for the cholesteryl derivative, theoxidation step was performed using the Beaucage reagent in order tointroduce a phosphorothioate linkage at the 5′-end of the nucleic acidoligomer.

Nucleic acid sequences are represented below using standardnomenclature, and specifically the abbreviations of Table 1.

TABLE 1 Abbreviations of nucleotide monomers used in nucleic acidsequence representation. It will be understood that these monomers, whenpresent in an oligonucleotide, are mutually linked by5′-3′-phosphodiester bonds. Abbreviation Nucleotide(s) Aadenosine-3′-phosphate C cytidine-3′-phosphate G guanosine-3′-phosphateT 5-methyluridine-3′-phosphate U uridine-3′-phosphate N any nucleotide(G, A, C, or T) a 2′-O-methyladenosine-3′-phosphate c2′-O-methylcytidine-3′-phosphate g 2′-O-methylguanosine-3′-phosphate u2′-O-methyluridine-3′-phosphate dT 2′-deoxythymidine-3′-phosphate sT;sdT 2′-deoxy-thymidine-5′phosphate-phosphorothioate

Example 2A TTR siRNA Design

Transcripts

siRNA design was carried out to identify siRNAs targeting the genetransthyretin from human (symbol TTR) and rat (symbol Ttr). The designused the TTR transcripts NM_(—)000371.2 (SEQ ID NO:1329) (human) andNM_(—)012681.1 (SEQ ID NO:1330) (rat) from the NCBI Refseq collection.The siRNA duplexes were designed with 100% identity to their respectiveTTR genes.

siRNA Design and Specificity Prediction

The predicted specificity of all possible 19 mers was determined foreach sequence. The TTR siRNAs were used in a comprehensive searchagainst the human and rat transcriptomes (defined as the set of NM_ andXM_records within the NCBI Refseq set) using the FASTA algorithm. ThePython script ‘offtargetFasta.py’ was then used to parse the alignmentsand generate a score based on the position and number of mismatchesbetween the siRNA and any potential ‘off-target’ transcript. Theoff-target score is weighted to emphasize differences in the ‘seed’region of siRNAs, in positions 2-9 from the 5′ end of the molecule. Theoff-target score is calculated as follows: mismatches between the oligoand the transcript are given penalties. A mismatch in the seed region inpositions 2-9 of the oligo is given a penalty of 2.8; mismatches in theputative cleavage sites 10 and 11 are given a penalty of 1.2, andmismatches in positions 12-19 a penalty of 1. Mismatches in position 1are not considered. The off-target score for each oligo-transcript pairis then calculated by summing the mismatch penalties. The lowestoff-target score from all the oligo-transcript pairs is then determinedand used in subsequent sorting of oligos. Both siRNA strands wereassigned to a category of specificity according to the calculatedscores: a score above 3 qualifies as highly specific, equal to 3 asspecific, and between 2.2 and 2.8 as moderately specific. In pickingwhich oligos to synthesize, off-target scores of the antisense strandwere sorted from high to low, and the 144 best (lowest off-target score)oligo pairs from human, and the best 26 pairs from rat were selected.

siRNA Sequence Selection

A total of 140 sense and 140 antisense human TTR derived siRNA oligoswere synthesized and formed into duplexes. A total of 26 sense and 26antisense rat TTR derived siRNA oligos were synthesized and formed intoduplexes. Duplexes included The oligos are presented in Tables 2-4(human TTR) and Tables 5-7 (rat TTR).

TABLE 2 Identification numbers for human TTR dsRNAs See Table 4 forsequences and modifications of oligos. Duplex # Sense Oligo # AntisenseOligo # AD-18243 A-32153 A-32154 AD-18244 A-32155 A-32156 AD-18245A-32157 A-32158 AD-18246 A-32159 A-32160 AD-18247 A-32163 A-32164AD-18248 A-32165 A-32166 AD-18249 A-32167 A-32168 AD-18250 A-32169A-32170 AD-18251 A-32171 A-32172 AD-18252 A-32175 A-32176 AD-18253A-32177 A-32178 AD-18254 A-32179 A-32180 AD-18255 A-32181 A-32182AD-18256 A-32183 A-32184 AD-18257 A-32187 A-32188 AD-18258 A-32189A-32190 AD-18259 A-32191 A-32192 AD-18260 A-32193 A-32194 AD-18261A-32195 A-32196 AD-18262 A-32199 A-32200 AD-18263 A-32201 A-32202AD-18264 A-32203 A-32204 AD-18265 A-32205 A-32206 AD-18266 A-32207A-32208 AD-18267 A-32211 A-32212 AD-18268 A-32213 A-32214 AD-18269A-32215 A-32216 AD-18270 A-32217 A-32218 AD-18271 A-32219 A-32220AD-18272 A-32221 A-32222 AD-18273 A-32223 A-32224 AD-18274 A-32225A-32226 AD-18275 A-32227 A-32228 AD-18276 A-32229 A-32230 AD-18277A-32231 A-32232 AD-18278 A-32233 A-32234 AD-18279 A-32235 A-32236AD-18280 A-32237 A-32238 AD-18281 A-32239 A-32240 AD-18282 A-32241A-32242 AD-18283 A-32243 A-32244 AD-18284 A-32247 A-32248 AD-18285A-32249 A-32250 AD-18286 A-32251 A-32252 AD-18287 A-32253 A-32254AD-18288 A-32255 A-32256 AD-18289 A-32259 A-32260 AD-18290 A-32261A-32262 AD-18291 A-32263 A-32264 AD-18292 A-32265 A-32266 AD-18293A-32267 A-32268 AD-18294 A-32269 A-32270 AD-18295 A-32271 A-32272AD-18296 A-32273 A-32274 AD-18297 A-32275 A-32276 AD-18298 A-32277A-32278 AD-18299 A-32279 A-32280 AD-18300 A-32281 A-32282 AD-18301A-32283 A-32284 AD-18302 A-32285 A-32286 AD-18303 A-32287 A-32288AD-18304 A-32289 A-32290 AD-18305 A-32291 A-32292 AD-18306 A-32295A-32296 AD-18307 A-32297 A-32298 AD-18308 A-32299 A-32300 AD-18309A-32301 A-32302 AD-18310 A-32303 A-32304 AD-18311 A-32307 A-32308AD-18312 A-32309 A-32310 AD-18313 A-32311 A-32312 AD-18314 A-32313A-32314 AD-18315 A-32315 A-32316 AD-18316 A-32319 A-32320 AD-18317A-32321 A-32322 AD-18318 A-32323 A-32324 AD-18319 A-32325 A-32326AD-18320 A-32327 A-32328 AD-18321 A-32331 A-32332 AD-18322 A-32333A-32334 AD-18323 A-32335 A-32336 AD-18324 A-32337 A-32338 AD-18325A-32339 A-32340 AD-18326 A-32341 A-32342 AD-18327 A-32343 A-32344AD-18328 A-32345 A-32346 AD-18329 A-32347 A-32348 AD-18330 A-32349A-32350 AD-18331 A-32351 A-32352 AD-18332 A-32353 A-32354 AD-18333A-32355 A-32356 AD-18334 A-32357 A-32358 AD-18335 A-32359 A-32360AD-18336 A-32363 A-32364 AD-18337 A-32367 A-32368 AD-18338 A-32369A-32370 AD-18339 A-32371 A-32372 AD-18340 A-32373 A-32374 AD-18341A-32375 A-32376 AD-18342 A-32379 A-32380 AD-18343 A-32381 A-32382AD-18344 A-32383 A-32384 AD-18345 A-32385 A-32386 AD-18346 A-32387A-32388 AD-18347 A-32391 A-32392 AD-18348 A-32393 A-32394 AD-18349A-32395 A-32396 AD-18350 A-32397 A-32398 AD-18351 A-32399 A-32400AD-18352 A-32401 A-32402 AD-18353 A-32403 A-32404 AD-18354 A-32405A-32406 AD-18355 A-32407 A-32408 AD-18356 A-32409 A-32410 AD-18357A-32411 A-32412 AD-18358 A-32415 A-32416 AD-18359 A-32417 A-32418AD-18360 A-32419 A-32420 AD-18361 A-32421 A-32422 AD-18362 A-32423A-32424 AD-18363 A-32427 A-32428 AD-18364 A-32429 A-32430 AD-18446A-32161 A-32162 AD-18447 A-32173 A-32174 AD-18448 A-32185 A-32186AD-18449 A-32197 A-32198 AD-18450 A-32209 A-32210 AD-18451 A-32245A-32246 AD-18452 A-32257 A-32258 AD-18453 A-32293 A-32294 AD-18454A-32305 A-32306 AD-18455 A-32317 A-32318 AD-18456 A-32329 A-32330AD-18457 A-32361 A-32362 AD-18458 A-32365 A-32366 AD-18459 A-32377A-32378 AD-18460 A-32389 A-32390 AD-18461 A-32401 A-32402 AD-18462A-32413 A-32414 AD-18463 A-32425 A-32426

TABLE 3A Sense and antisense strand sequences of human TTR dsRNAs SEQSequence with 3′ SEQ Sequence ID dinucleotide overhang ID StrandPosition (5′ to 3′) NO: (5′ to 3′) NO: S 100 CCGGUGAAUCCAAGUGUCC 1CCGGUGAAUCCAAGUGUCCNN 281 as 118 GGACACUUGGAUUCACCGG 2GGACACUUGGAUUCACCGGNN 282 S 11 ACUCAUUCUUGGCAGGAUG 3ACUCAUUCUUGGCAGGAUGNN 283 as 29 CAUCCUGCCAAGAAUGAGU 4CAUCCUGCCAAGAAUGAGUNN 284 S 111 AAGUGUCCUCUGAUGGUCA 5AAGUGUCCUCUGAUGGUCANN 285 as 129 UGACCAUCAGAGGACACUU 6UGACCAUCAGAGGACACUUNN 286 S 13 UCAUUCUUGGCAGGAUGGC 7UCAUUCUUGGCAGGAUGGCNN 287 as 31 GCCAUCCUGCCAAGAAUGA 8GCCAUCCUGCCAAGAAUGANN 288 s 130 AAGUUCUAGAUGCUGUCCG 9AAGUUCUAGAUGCUGUCCGNN 289 as 148 CGGACAGCAUCUAGAACUU 10CGGACAGCAUCUAGAACUUNN 290 s 132 GUUCUAGAUGCUGUCCGAG 11GUUCUAGAUGCUGUCCGAGNN 291 as 150 CUCGGACAGCAUCUAGAAC 12CUCGGACAGCAUCUAGAACNN 292 s 135 CUAGAUGCUGUCCGAGGCA 13CUAGAUGCUGUCCGAGGCANN 293 as 153 UGCCUCGGACAGCAUCUAG 14UGCCUCGGACAGCAUCUAGNN 294 s 138 GAUGCUGUCCGAGGCAGUC 15GAUGCUGUCCGAGGCAGUCNN 295 as 156 GACUGCCUCGGACAGCAUC 16GACUGCCUCGGACAGCAUCNN 296 s 14 CAUUCUUGGCAGGAUGGCU 17CAUUCUUGGCAGGAUGGCUNN 297 as 32 AGCCAUCCUGCCAAGAAUG 18AGCCAUCCUGCCAAGAAUGNN 298 s 140 UGCUGUCCGAGGCAGUCCU 19UGCUGUCCGAGGCAGUCCUNN 299 as 158 AGGACUGCCUCGGACAGCA 20AGGACUGCCUCGGACAGCANN 300 s 146 CCGAGGCAGUCCUGCCAUC 21CCGAGGCAGUCCUGCCAUCNN 301 as 164 GAUGGCAGGACUGCCUCGG 22GAUGGCAGGACUGCCUCGGNN 302 s 152 CAGUCCUGCCAUCAAUGUG 23CAGUCCUGCCAUCAAUGUGNN 303 as 170 CACAUUGAUGGCAGGACUG 24CACAUUGAUGGCAGGACUGNN 304 s 164 CAAUGUGGCCGUGCAUGUG 25CAAUGUGGCCGUGCAUGUGNN 305 as 182 CACAUGCACGGCCACAUUG 26CACAUGCACGGCCACAUUGNN 306 s 178 AUGUGUUCAGAAAGGCUGC 27AUGUGUUCAGAAAGGCUGCNN 307 as 196 GCAGCCUUUCUGAACACAU 28GCAGCCUUUCUGAACACAUNN 308 s 2 CAGAAGUCCACUCAUUCUU 29CAGAAGUCCACUCAUUCUUNN 309 as 20 AAGAAUGAGUGGACUUCUG 30AAGAAUGAGUGGACUUCUGNN 310 s 21 GGCAGGAUGGCUUCUCAUC 31GGCAGGAUGGCUUCUCAUCNN 311 as 39 GAUGAGAAGCCAUCCUGCC 32GAUGAGAAGCCAUCCUGCCNN 312 s 210 GAGCCAUUUGCCUCUGGGA 33GAGCCAUUUGCCUCUGGGANN 313 as 228 UCCCAGAGGCAAAUGGCUC 34UCCCAGAGGCAAAUGGCUCNN 314 s 23 CAGGAUGGCUUCUCAUCGU 35CAGGAUGGCUUCUCAUCGUNN 315 as 41 ACGAUGAGAAGCCAUCCUG 36ACGAUGAGAAGCCAUCCUGNN 316 s 24 AGGAUGGCUUCUCAUCGUC 37AGGAUGGCUUCUCAUCGUCNN 317 as 42 GACGAUGAGAAGCCAUCCU 38GACGAUGAGAAGCCAUCCUNN 318 s 245 AGAGCUGCAUGGGCUCACA 39AGAGCUGCAUGGGCUCACANN 319 as 263 UGUGAGCCCAUGCAGCUCU 40UGUGAGCCCAUGCAGCUCUNN 320 s 248 GCUGCAUGGGCUCACAACU 41GCUGCAUGGGCUCACAACUNN 321 as 266 AGUUGUGAGCCCAUGCAGC 42AGUUGUGAGCCCAUGCAGCNN 322 s 25 GGAUGGCUUCUCAUCGUCU 43GGAUGGCUUCUCAUCGUCUNN 323 as 43 AGACGAUGAGAAGCCAUCC 44AGACGAUGAGAAGCCAUCCNN 324 s 251 GCAUGGGCUCACAACUGAG 45GCAUGGGCUCACAACUGAGNN 325 as 269 CUCAGUUGUGAGCCCAUGC 46CUCAGUUGUGAGCCCAUGCNN 326 s 253 AUGGGCUCACAACUGAGGA 47AUGGGCUCACAACUGAGGANN 327 as 271 UCCUCAGUUGUGAGCCCAU 48UCCUCAGUUGUGAGCCCAUNN 328 s 254 UGGGCUCACAACUGAGGAG 49UGGGCUCACAACUGAGGAGNN 329 as 272 CUCCUCAGUUGUGAGCCCA 50CUCCUCAGUUGUGAGCCCANN 330 s 270 GAGGAAUUUGUAGAAGGGA 51GAGGAAUUUGUAGAAGGGANN 331 as 288 UCCCUUCUACAAAUUCCUC 52UCCCUUCUACAAAUUCCUCNN 332 s 276 UUUGUAGAAGGGAUAUACA 53UUUGUAGAAGGGAUAUACANN 333 as 294 UGUAUAUCCCUUCUACAAA 54UGUAUAUCCCUUCUACAAANN 334 s 277 UUGUAGAAGGGAUAUACAA 55UUGUAGAAGGGAUAUACAANN 335 as 295 UUGUAUAUCCCUUCUACAA 56UUGUAUAUCCCUUCUACAANN 336 s 278 UGUAGAAGGGAUAUACAAA 57UGUAGAAGGGAUAUACAAANN 337 as 296 UUUGUAUAUCCCUUCUACA 58UUUGUAUAUCCCUUCUACANN 338 s 281 AGAAGGGAUAUACAAAGUG 59AGAAGGGAUAUACAAAGUGNN 339 as 299 CACUUUGUAUAUCCCUUCU 60CACUUUGUAUAUCCCUUCUNN 340 s 295 AAGUGGAAAUAGACACCAA 61AAGUGGAAAUAGACACCAANN 341 as 313 UUGGUGUCUAUUUCCACUU 62UUGGUGUCUAUUUCCACUUNN 342 s 299 GGAAAUAGACACCAAAUCU 63GGAAAUAGACACCAAAUCUNN 343 as 317 AGAUUUGGUGUCUAUUUCC 64AGAUUUGGUGUCUAUUUCCNN 344 s 300 GAAAUAGACACCAAAUCUU 65GAAAUAGACACCAAAUCUUNN 345 as 318 AAGAUUUGGUGUCUAUUUC 66AAGAUUUGGUGUCUAUUUCNN 346 s 303 AUAGACACCAAAUCUUACU 67AUAGACACCAAAUCUUACUNN 347 as 321 AGUAAGAUUUGGUGUCUAU 68AGUAAGAUUUGGUGUCUAUNN 348 s 304 UAGACACCAAAUCUUACUG 69UAGACACCAAAUCUUACUGNN 349 as 322 CAGUAAGAUUUGGUGUCUA 70CAGUAAGAUUUGGUGUCUANN 350 s 305 AGACACCAAAUCUUACUGG 71AGACACCAAAUCUUACUGGNN 351 as 323 CCAGUAAGAUUUGGUGUCU 72CCAGUAAGAUUUGGUGUCUNN 352 s 317 UUACUGGAAGGCACUUGGC 73UUACUGGAAGGCACUUGGCNN 353 as 335 GCCAAGUGCCUUCCAGUAA 74GCCAAGUGCCUUCCAGUAANN 354 s 32 UUCUCAUCGUCUGCUCCUC 75UUCUCAUCGUCUGCUCCUCNN 355 as 50 GAGGAGCAGACGAUGAGAA 76GAGGAGCAGACGAUGAGAANN 356 s 322 GGAAGGCACUUGGCAUCUC 77GGAAGGCACUUGGCAUCUCNN 357 as 340 GAGAUGCCAAGUGCCUUCC 78GAGAUGCCAAGUGCCUUCCNN 358 s 326 GGCACUUGGCAUCUCCCCA 79GGCACUUGGCAUCUCCCCANN 359 as 344 UGGGGAGAUGCCAAGUGCC 80UGGGGAGAUGCCAAGUGCCNN 360 s 333 GGCAUCUCCCCAUUCCAUG 81GGCAUCUCCCCAUUCCAUGNN 361 as 351 AUGGAAUGGGGAGAUGCCTT 82AUGGAAUGGGGAGAUGCCTTNN 362 s 334 GCAUCUCCCCAUUCCAUGA 83GCAUCUCCCCAUUCCAUGANN 363 as 352 UCAUGGAAUGGGGAGAUGC 84UCAUGGAAUGGGGAGAUGCNN 364 s 335 CAUCUCCCCAUUCCAUGAG 85CAUCUCCCCAUUCCAUGAGNN 365 as 353 CUCAUGGAAUGGGGAGAUG 86CUCAUGGAAUGGGGAGAUGNN 366 s 336 AUCUCCCCAUUCCAUGAGC 87AUCUCCCCAUUCCAUGAGCNN 367 as 354 GCUCAUGGAAUGGGGAGAU 88GCUCAUGGAAUGGGGAGAUNN 368 s 338 CUCCCCAUUCCAUGAGCAU 89CUCCCCAUUCCAUGAGCAUNN 369 as 356 AUGCUCAUGGAAUGGGGAG 90AUGCUCAUGGAAUGGGGAGNN 370 s 341 CCCAUUCCAUGAGCAUGCA 91CCCAUUCCAUGAGCAUGCANN 371 as 359 UGCAUGCUCAUGGAAUGGG 92UGCAUGCUCAUGGAAUGGGNN 372 s 347 CCAUGAGCAUGCAGAGGUG 93CCAUGAGCAUGCAGAGGUGNN 373 as 365 CACCUCUGCAUGCUCAUGG 94CACCUCUGCAUGCUCAUGGNN 374 s 352 AGCAUGCAGAGGUGGUAUU 95AGCAUGCAGAGGUGGUAUUNN 375 as 370 AAUACCACCUCUGCAUGCU 96AAUACCACCUCUGCAUGCUNN 376 s 354 CAUGCAGAGGUGGUAUUCA 97CAUGCAGAGGUGGUAUUCANN 377 as 372 UGAAUACCACCUCUGCAUG 98UGAAUACCACCUCUGCAUGNN 378 s 355 AUGCAGAGGUGGUAUUCAC 99AUGCAGAGGUGGUAUUCACNN 379 as 373 GUGAAUACCACCUCUGCAU 100GUGAAUACCACCUCUGCAUNN 380 s 362 GGUGGUAUUCACAGCCAAC 101GGUGGUAUUCACAGCCAACNN 381 as 380 GUUGGCUGUGAAUACCACC 102GUUGGCUGUGAAUACCACCNN 382 s 363 GUGGUAUUCACAGCCAACG 103GUGGUAUUCACAGCCAACGNN 383 as 381 CGUUGGCUGUGAAUACCAC 104CGUUGGCUGUGAAUACCACNN 384 s 364 UGGUAUUCACAGCCAACGA 105UGGUAUUCACAGCCAACGANN 385 as 382 UCGUUGGCUGUGAAUACCA 106UCGUUGGCUGUGAAUACCANN 386 s 365 GGUAUUCACAGCCAACGAC 107GGUAUUCACAGCCAACGACNN 387 as 383 GUCGUUGGCUGUGAAUACC 108GUCGUUGGCUGUGAAUACCNN 388 s 366 GUAUUCACAGCCAACGACU 109GUAUUCACAGCCAACGACUNN 389 as 384 AGUCGUUGGCUGUGAAUAC 110AGUCGUUGGCUGUGAAUACNN 390 s 367 UAUUCACAGCCAACGACUC 111UAUUCACAGCCAACGACUCNN 391 as 385 GAGUCGUUGGCUGUGAAUA 112GAGUCGUUGGCUGUGAAUANN 392 s 370 UCACAGCCAACGACUCCGG 113UCACAGCCAACGACUCCGGNN 393 as 388 CCGGAGUCGUUGGCUGUGA 114CCGGAGUCGUUGGCUGUGANN 394 s 390 CCCCGCCGCUACACCAUUG 115CCCCGCCGCUACACCAUUGNN 395 as 408 CAAUGGUGUAGCGGCGGGG 116CAAUGGUGUAGCGGCGGGGNN 396 s 4 GAAGUCCACUCAUUCUUGG 117GAAGUCCACUCAUUCUUGGNN 397 as 22 CCAAGAAUGAGUGGACUUC 118CCAAGAAUGAGUGGACUUCNN 398 s 412 CCCUGCUGAGCCCCUACUC 119CCCUGCUGAGCCCCUACUCNN 399 as 430 GAGUAGGGGCUCAGCAGGG 120GAGUAGGGGCUCAGCAGGGNN 400 s 417 CUGAGCCCCUACUCCUAUU 121CUGAGCCCCUACUCCUAUUNN 401 as 435 AAUAGGAGUAGGGGCUCAG 122AAUAGGAGUAGGGGCUCAGNN 402 s 418 UGAGCCCCUACUCCUAUUC 123UGAGCCCCUACUCCUAUUCNN 403 as 436 GAAUAGGAGUAGGGGCUCA 124GAAUAGGAGUAGGGGCUCANN 404 s 422 CCCCUACUCCUAUUCCACC 125CCCCUACUCCUAUUCCACCNN 405 as 440 GGUGGAAUAGGAGUAGGGG 126GGUGGAAUAGGAGUAGGGGNN 406 s 425 CUACUCCUAUUCCACCACG 127CUACUCCUAUUCCACCACGNN 407 as 443 CGUGGUGGAAUAGGAGUAG 128CGUGGUGGAAUAGGAGUAGNN 408 s 426 UACUCCUAUUCCACCACGG 129UACUCCUAUUCCACCACGGNN 409 as 444 CCGUGGUGGAAUAGGAGUA 130CCGUGGUGGAAUAGGAGUANN 410 s 427 ACUCCUAUUCCACCACGGC 131ACUCCUAUUCCACCACGGCNN 411 as 445 GCCGUGGUGGAAUAGGAGU 132GCCGUGGUGGAAUAGGAGUNN 412 s 429 UCCUAUUCCACCACGGCUG 133UCCUAUUCCACCACGGCUGNN 413 as 447 CAGCCGUGGUGGAAUAGGA 134CAGCCGUGGUGGAAUAGGANN 414 s 432 UAUUCCACCACGGCUGUCG 135UAUUCCACCACGGCUGUCGNN 415 as 450 CGACAGCCGUGGUGGAAUA 136CGACAGCCGUGGUGGAAUANN 416 s 433 AUUCCACCACGGCUGUCGU 137AUUCCACCACGGCUGUCGUNN 417 as 451 ACGACAGCCGUGGUGGAAU 138ACGACAGCCGUGGUGGAAUNN 418 s 437 CACCACGGCUGUCGUCACC 139CACCACGGCUGUCGUCACCNN 419 as 455 GGUGACGACAGCCGUGGUG 140GGUGACGACAGCCGUGGUGNN 420 s 438 ACCACGGCUGUCGUCACCA 141ACCACGGCUGUCGUCACCANN 421 as 456 UGGUGACGACAGCCGUGGU 142UGGUGACGACAGCCGUGGUNN 422 s 439 CCACGGCUGUCGUCACCAA 143CCACGGCUGUCGUCACCAANN 423 as 457 UUGGUGACGACAGCCGUGG 144UUGGUGACGACAGCCGUGGNN 424 s 441 ACGGCUGUCGUCACCAAUC 145ACGGCUGUCGUCACCAAUCNN 425 as 459 GAUUGGUGACGACAGCCGU 146GAUUGGUGACGACAGCCGUNN 426 s 442 CGGCUGUCGUCACCAAUCC 147CGGCUGUCGUCACCAAUCCNN 427 as 460 GGAUUGGUGACGACAGCCG 148GGAUUGGUGACGACAGCCGNN 428 s 449 CGUCACCAAUCCCAAGGAA 149CGUCACCAAUCCCAAGGAANN 429 as 467 UUCCUUGGGAUUGGUGACG 150UUCCUUGGGAUUGGUGACGNN 430 s 455 CAAUCCCAAGGAAUGAGGG 151CAAUCCCAAGGAAUGAGGGNN 431 as 473 CCCUCAUUCCUUGGGAUUG 152CCCUCAUUCCUUGGGAUUGNN 432 s 491 CCUGAAGGACGAGGGAUGG 153CCUGAAGGACGAGGGAUGGNN 433 as 509 CCAUCCCUCGUCCUUCAGG 154CCAUCCCUCGUCCUUCAGGNN 434 s 497 GGACGAGGGAUGGGAUUUC 155GGACGAGGGAUGGGAUUUCNN 435 as 515 GAAAUCCCAUCCCUCGUCC 156GAAAUCCCAUCCCUCGUCCNN 436 s 5 AAGUCCACUCAUUCUUGGC 157AAGUCCACUCAUUCUUGGCNN 437 as 23 GCCAAGAAUGAGUGGACUU 158GCCAAGAAUGAGUGGACUUNN 438 s 508 GGGAUUUCAUGUAACCAAG 159GGGAUUUCAUGUAACCAAGNN 439 as 526 CUUGGUUACAUGAAAUCCC 160CUUGGUUACAUGAAAUCCCNN 440 s 509 GGAUUUCAUGUAACCAAGA 161GGAUUUCAUGUAACCAAGANN 441 as 527 UCUUGGUUACAUGAAAUCC 162UCUUGGUUACAUGAAAUCCNN 442 s 514 UCAUGUAACCAAGAGUAUU 163UCAUGUAACCAAGAGUAUUNN 443 as 532 AAUACUCUUGGUUACAUGA 164AAUACUCUUGGUUACAUGANN 444 s 516 AUGUAACCAAGAGUAUUCC 165AUGUAACCAAGAGUAUUCCNN 445 as 534 GGAAUACUCUUGGUUACAU 166GGAAUACUCUUGGUUACAUNN 446 s 517 UGUAACCAAGAGUAUUCCA 167UGUAACCAAGAGUAUUCCANN 447 as 535 UGGAAUACUCUUGGUUACA 168UGGAAUACUCUUGGUUACANN 448 s 518 GUAACCAAGAGUAUUCCAU 169GUAACCAAGAGUAUUCCAUNN 449 as 536 AUGGAAUACUCUUGGUUAC 170AUGGAAUACUCUUGGUUACNN 450 s 54 UGCCUUGCUGGACUGGUAU 171UGCCUUGCUGGACUGGUAUNN 451 as 72 AUACCAGUCCAGCAAGGCA 172AUACCAGUCCAGCAAGGCANN 452 s 543 UAAAGCAGUGUUUUCACCU 173UAAAGCAGUGUUUUCACCUNN 453 as 561 AGGUGAAAACACUGCUUUA 174AGGUGAAAACACUGCUUUANN 454 s 55 GCCUUGCUGGACUGGUAUU 175GCCUUGCUGGACUGGUAUUNN 455 as 73 AAUACCAGUCCAGCAAGGC 176AAUACCAGUCCAGCAAGGCNN 456 s 551 UGUUUUCACCUCAUAUGCU 177UGUUUUCACCUCAUAUGCUNN 457 as 569 AGCAUAUGAGGUGAAAACA 178AGCAUAUGAGGUGAAAACANN 458 s 552 GUUUUCACCUCAUAUGCUA 179GUUUUCACCUCAUAUGCUANN 459 as 570 UAGCAUAUGAGGUGAAAAC 180UAGCAUAUGAGGUGAAAACNN 460 s 553 UUUUCACCUCAUAUGCUAU 181UUUUCACCUCAUAUGCUAUNN 461 as 571 AUAGCAUAUGAGGUGAAAA 182AUAGCAUAUGAGGUGAAAANN 462 s 555 UUCACCUCAUAUGCUAUGU 183UUCACCUCAUAUGCUAUGUNN 463 as 573 ACAUAGCAUAUGAGGUGAA 184ACAUAGCAUAUGAGGUGAANN 464 s 557 CACCUCAUAUGCUAUGUUA 185CACCUCAUAUGCUAUGUUANN 465 as 575 UAACAUAGCAUAUGAGGUG 186UAACAUAGCAUAUGAGGUGNN 466 s 56 CCUUGCUGGACUGGUAUUU 187CCUUGCUGGACUGGUAUUUNN 467 as 74 AAAUACCAGUCCAGCAAGG 188AAAUACCAGUCCAGCAAGGNN 468 s 563 AUAUGCUAUGUUAGAAGUC 189AUAUGCUAUGUUAGAAGUCNN 469 as 581 GACUUCUAACAUAGCAUAU 190GACUUCUAACAUAGCAUAUNN 470 s 564 UAUGCUAUGUUAGAAGUCC 191UAUGCUAUGUUAGAAGUCCNN 471 as 582 GGACUUCUAACAUAGCAUA 192GGACUUCUAACAUAGCAUANN 472 s 566 UGCUAUGUUAGAAGUCCAG 193UGCUAUGUUAGAAGUCCAGNN 473 as 584 CUGGACUUCUAACAUAGCA 194CUGGACUUCUAACAUAGCANN 474 s 57 CUUGCUGGACUGGUAUUUG 195CUUGCUGGACUGGUAUUUGNN 475 as 75 CAAAUACCAGUCCAGCAAG 196CAAAUACCAGUCCAGCAAGNN 476 s 578 AGUCCAGGCAGAGACAAUA 197AGUCCAGGCAGAGACAAUANN 477 as 596 AUUGUCUCUGCCUGGACUTT 198AUUGUCUCUGCCUGGACUTTNN 478 s 580 UCCAGGCAGAGACAAUAAA 199UCCAGGCAGAGACAAUAAANN 479 as 598 UUUAUUGUCUCUGCCUGGA 200UUUAUUGUCUCUGCCUGGANN 480 s 607 GUGAAAGGCACUUUUCAUU 201GUGAAAGGCACUUUUCAUUNN 481 as 625 AAUGAAAAGUGCCUUUCAC 202AAUGAAAAGUGCCUUUCACNN 482 s 62 UGGACUGGUAUUUGUGUCU 203UGGACUGGUAUUUGUGUCUNN 483 as 80 AGACACAAAUACCAGUCCA 204AGACACAAAUACCAGUCCANN 484 s 77 GUCUGAGGCUGGCCCUACG 205GUCUGAGGCUGGCCCUACGNN 485 as 95 CGUAGGGCCAGCCUCAGAC 206CGUAGGGCCAGCCUCAGACNN 486 s 79 CUGAGGCUGGCCCUACGGG 207CUGAGGCUGGCCCUACGGGNN 487 as 97 CCCGUAGGGCCAGCCUCAG 208CCCGUAGGGCCAGCCUCAGNN 488 s 81 GAGGCUGGCCCUACGGGCA 209GAGGCUGGCCCUACGGGCANN 489 as 99 UGCCCGUAGGGCCAGCCUC 210UGCCCGUAGGGCCAGCCUCNN 490 s 82 AGGCUGGCCCUACGGGCAC 211AGGCUGGCCCUACGGGCACNN 491 as 100 GUGCCCGUAGGGCCAGCCU 212GUGCCCGUAGGGCCAGCCUNN 492 s 84 GCUGGCCCUACGGGCACCG 213GCUGGCCCUACGGGCACCGNN 493 as 102 CGGUGCCCGUAGGGCCAGC 214CGGUGCCCGUAGGGCCAGCNN 494 s 85 CUGGCCCUACGGGCACCGG 215CUGGCCCUACGGGCACCGGNN 495 as 103 CCGGUGCCCGUAGGGCCAG 216CCGGUGCCCGUAGGGCCAGNN 496 s 87 GGCCCUACGGGCACCGGUG 217GGCCCUACGGGCACCGGUGNN 497 as 105 CACCGGUGCCCGUAGGGCC 218CACCGGUGCCCGUAGGGCCNN 498 s 9 CCACUCAUUCUUGGCAGGA 219CCACUCAUUCUUGGCAGGANN 499 as 27 UCCUGCCAAGAAUGAGUGG 220UCCUGCCAAGAAUGAGUGGNN 500 s 90 CCUACGGGCACCGGUGAAU 221CCUACGGGCACCGGUGAAUNN 501 as 108 AUUCACCGGUGCCCGUAGG 222AUUCACCGGUGCCCGUAGGNN 502 s 91 CUACGGGCACCGGUGAAUC 223CUACGGGCACCGGUGAAUCNN 503 as 109 GAUUCACCGGUGCCCGUAG 224GAUUCACCGGUGCCCGUAGNN 504 s 92 UACGGGCACCGGUGAAUCC 225UACGGGCACCGGUGAAUCCNN 505 as 110 GGAUUCACCGGUGCCCGUA 226GGAUUCACCGGUGCCCGUANN 506 s 93 ACGGGCACCGGUGAAUCCA 227ACGGGCACCGGUGAAUCCANN 507 as 111 UGGAUUCACCGGUGCCCGU 228UGGAUUCACCGGUGCCCGUNN 508 s 97 GCACCGGUGAAUCCAAGUG 229GCACCGGUGAAUCCAAGUGNN 509 as 115 CACUUGGAUUCACCGGUGC 230CACUUGGAUUCACCGGUGCNN 510 s 98 CACCGGUGAAUCCAAGUGU 231CACCGGUGAAUCCAAGUGUNN 511 as 116 ACACUUGGAUUCACCGGUG 232ACACUUGGAUUCACCGGUGNN 512 s 167 UGUGGCCAUGCAUGUGUUC 233UGUGGCCAUGCAUGUGUUCNN 513 as 185 GAACACAUGCAUGGCCACA 234GAACACAUGCAUGGCCACANN 514 s 168 GUGGCCAUGCAUGUGUUCA 235GUGGCCAUGCAUGUGUUCANN 515 as 186 UGAACACAUGCAUGGCCAC 236UGAACACAUGCAUGGCCACNN 516 s 171 GCCAUGCAUGUGUUCAGAA 237GCCAUGCAUGUGUUCAGAANN 517 as 189 UUCUGAACACAUGCAUGGC 238UUCUGAACACAUGCAUGGCNN 518 s 432 UAUUCCACCACGGCUGUCA 239UAUUCCACCACGGCUGUCANN 519 as 449 UGACAGCCGUGGUGGAAUA 240UGACAGCCGUGGUGGAAUANN 520 s 447 GUCAUCACCAAUCCCAAGG 241GUCAUCACCAAUCCCAAGGNN 521 as 465 CCUUGGGAUUGGUGAUGAC 242CCUUGGGAUUGGUGAUGACNN 522 s 115 GUCCUCUGAUGGUCAAAGU 243GUCCUCUGAUGGUCAAAGUNN 523 as 133 ACUUUGACCAUCAGAGGAC 244ACUUUGACCAUCAGAGGACNN 524 s 122 GAUGGUCAAAGUUCUAGAU 245GAUGGUCAAAGUUCUAGAUNN 525 as 140 AUCUAGAACUUUGACCAUC 246AUCUAGAACUUUGACCAUCNN 526 s 139 AUGCUGUCCGAGGCAGUCC 247AUGCUGUCCGAGGCAGUCCNN 527 as 157 GGACUGCCUCGGACAGCAU 248GGACUGCCUCGGACAGCAUNN 528 s 172 CCGUGCAUGUGUUCAGAAA 249CCGUGCAUGUGUUCAGAAANN 529 as 190 UUUCUGAACACAUGCACGG 250UUUCUGAACACAUGCACGGNN 530 s 238 AGUCUGGAGAGCUGCAUGG 251AGUCUGGAGAGCUGCAUGGNN 531 as 256 CCAUGCAGCUCUCCAGACU 252CCAUGCAGCUCUCCAGACUNN 532 s 252 CAUGGGCUCACAACUGAGG 253CAUGGGCUCACAACUGAGGNN 533 as 270 CCUCAGUUGUGAGCCCAUG 254CCUCAGUUGUGAGCCCAUGNN 534 s 33 UCUCAUCGUCUGCUCCUCC 255UCUCAUCGUCUGCUCCUCCNN 535 as 51 GGAGGAGCAGACGAUGAGA 256GGAGGAGCAGACGAUGAGANN 536 s 340 CCCCAUUCCAUGAGCAUGC 257CCCCAUUCCAUGAGCAUGCNN 537 as 358 GCAUGCUCAUGGAAUGGGG 258GCAUGCUCAUGGAAUGGGGNN 538 s 421 GCCCCUACUCCUAUUCCAC 259GCCCCUACUCCUAUUCCACNN 539 as 439 GUGGAAUAGGAGUAGGGGC 260GUGGAAUAGGAGUAGGGGCNN 540 s 431 CUAUUCCACCACGGCUGUC 261CUAUUCCACCACGGCUGUCNN 541 as 449 GACAGCCGUGGUGGAAUAG 262GACAGCCGUGGUGGAAUAGNN 542 s 440 CACGGCUGUCGUCACCAAU 263CACGGCUGUCGUCACCAAUNN 543 as 458 AUUGGUGACGACAGCCGUG 264AUUGGUGACGACAGCCGUGNN 544 s 496 AGGACGAGGGAUGGGAUUU 265AGGACGAGGGAUGGGAUUUNN 545 as 514 AAAUCCCAUCCCUCGUCCU 266AAAUCCCAUCCCUCGUCCUNN 546 s 556 UCACCUCAUAUGCUAUGUU 267UCACCUCAUAUGCUAUGUUNN 547 as 574 AACAUAGCAUAUGAGGUGA 268AACAUAGCAUAUGAGGUGANN 548 s 559 CCUCAUAUGCUAUGUUAGA 269CCUCAUAUGCUAUGUUAGANN 549 as 577 UCUAACAUAGCAUAUGAGG 270UCUAACAUAGCAUAUGAGGNN 550 s 570 AUGUUAGAAGUCCAGGCAG 271AUGUUAGAAGUCCAGGCAGNN 551 as 588 CUGCCUGGACUUCUAACAU 272CUGCCUGGACUUCUAACAUNN 552 s 78 UCUGAGGCUGGCCCUACGG 273UCUGAGGCUGGCCCUACGGNN 553 as 96 CCGUAGGGCCAGCCUCAGA 274CCGUAGGGCCAGCCUCAGANN 554 s 87 GGCCCUACGGGCACCGGUG 275GGCCCUACGGGCACCGGUGNN 555 as 105 CACCGGUGCCCGUAGGGCC 276CACCGGUGCCCGUAGGGCCNN 556 s 95 GGGCACCGGUGAAUCCAAG 277GGGCACCGGUGAAUCCAAGNN 557 as 113 CUUGGAUUCACCGGUGCCC 278CUUGGAUUCACCGGUGCCCNN 558 s 167 CCAUGCAUGUGUUCAGAAA 279CCAUGCAUGUGUUCAGAAANN 559 as 185 UUUCUGAACACAUGCAUGG 280UUUCUGAACACAUGCAUGGNN 560 Strand: s = sense; as = antisense; Position:position of 5′ base on transcript (NM_000371.2, SEQ ID NO: 1329)

TABLE 3B Sense and antisense strand sequences of human TTR dsRNAsSequence with 3′deoxythimidine overhang Strand Position (5′ to 3′)SEQ ID NO: s 100 CCGGUGAAUCCAAGUGUCCdTdT 561 as 118GGACACUUGGAUUCACCGGdTdT 562 s 11 ACUCAUUCUUGGCAGGAUGdTdT 563 as 29CAUCCUGCCAAGAAUGAGUdTdT 564 s 111 AAGUGUCCUCUGAUGGUCAdTdT 565 as 129UGACCAUCAGAGGACACUUdTdT 566 s 13 UCAUUCUUGGCAGGAUGGCdTdT 567 as 31GCCAUCCUGCCAAGAAUGAdTdT 568 s 130 AAGUUCUAGAUGCUGUCCGdTdT 569 as 148CGGACAGCAUCUAGAACUUdTdT 570 s 132 GUUCUAGAUGCUGUCCGAGdTdT 571 as 150CUCGGACAGCAUCUAGAACdTdT 572 s 135 CUAGAUGCUGUCCGAGGCAdTdT 573 as 153UGCCUCGGACAGCAUCUAGdTdT 574 s 138 GAUGCUGUCCGAGGCAGUCdTdT 575 as 156GACUGCCUCGGACAGCAUCdTdT 576 s 14 CAUUCUUGGCAGGAUGGCUdTdT 577 as 32AGCCAUCCUGCCAAGAAUGdTdT 578 s 140 UGCUGUCCGAGGCAGUCCUdTdT 579 as 158AGGACUGCCUCGGACAGCAdTdT 580 s 146 CCGAGGCAGUCCUGCCAUCdTdT 581 as 164GAUGGCAGGACUGCCUCGGdTdT 582 s 152 CAGUCCUGCCAUCAAUGUGdTdT 583 as 170CACAUUGAUGGCAGGACUGdTdT 584 s 164 CAAUGUGGCCGUGCAUGUGdTdT 585 as 182CACAUGCACGGCCACAUUGdTdT 586 s 178 AUGUGUUCAGAAAGGCUGCdTdT 587 as 196GCAGCCUUUCUGAACACAUdTdT 588 s 2 CAGAAGUCCACUCAUUCUUdTdT 589 as 20AAGAAUGAGUGGACUUCUGdTdT 590 s 21 GGCAGGAUGGCUUCUCAUCdTdT 591 as 39GAUGAGAAGCCAUCCUGCCdTdT 592 s 210 GAGCCAUUUGCCUCUGGGAdTdT 593 as 228UCCCAGAGGCAAAUGGCUCdTdT 594 s 23 CAGGAUGGCUUCUCAUCGUdTdT 595 as 41ACGAUGAGAAGCCAUCCUGdTdT 596 s 24 AGGAUGGCUUCUCAUCGUCdTdT 597 as 42GACGAUGAGAAGCCAUCCUdTdT 598 s 245 AGAGCUGCAUGGGCUCACAdTdT 599 as 263UGUGAGCCCAUGCAGCUCUdTdT 600 s 248 GCUGCAUGGGCUCACAACUdTdT 601 as 266AGUUGUGAGCCCAUGCAGCdTdT 602 s 25 GGAUGGCUUCUCAUCGUCUdTdT 603 as 43AGACGAUGAGAAGCCAUCCdTdT 604 s 251 GCAUGGGCUCACAACUGAGdTdT 605 as 269CUCAGUUGUGAGCCCAUGCdTdT 606 s 253 AUGGGCUCACAACUGAGGAdTdT 607 as 271UCCUCAGUUGUGAGCCCAUdTdT 608 s 254 UGGGCUCACAACUGAGGAGdTdT 609 as 272CUCCUCAGUUGUGAGCCCAdTdT 610 s 270 GAGGAAUUUGUAGAAGGGAdTdT 611 as 288UCCCUUCUACAAAUUCCUCdTdT 612 s 276 UUUGUAGAAGGGAUAUACAdTdT 613 as 294UGUAUAUCCCUUCUACAAAdTdT 614 s 277 UUGUAGAAGGGAUAUACAAdTdT 615 as 295UUGUAUAUCCCUUCUACAAdTdT 616 s 278 UGUAGAAGGGAUAUACAAAdTdT 617 as 296UUUGUAUAUCCCUUCUACAdTdT 618 s 281 AGAAGGGAUAUACAAAGUGdTdT 619 as 299CACUUUGUAUAUCCCUUCUdTdT 620 s 295 AAGUGGAAAUAGACACCAAdTdT 621 as 313UUGGUGUCUAUUUCCACUUdTdT 622 s 299 GGAAAUAGACACCAAAUCUdTdT 623 as 317AGAUUUGGUGUCUAUUUCCdTdT 624 s 300 GAAAUAGACACCAAAUCUUdTdT 625 as 318AAGAUUUGGUGUCUAUUUCdTdT 626 s 303 AUAGACACCAAAUCUUACUdTdT 627 as 321AGUAAGAUUUGGUGUCUAUdTdT 628 s 304 UAGACACCAAAUCUUACUGdTdT 629 as 322CAGUAAGAUUUGGUGUCUAdTdT 630 s 305 AGACACCAAAUCUUACUGGdTdT 631 as 323CCAGUAAGAUUUGGUGUCUdTdT 632 s 317 UUACUGGAAGGCACUUGGCdTdT 633 as 335GCCAAGUGCCUUCCAGUAAdTdT 634 s 32 UUCUCAUCGUCUGCUCCUCdTdT 635 as 50GAGGAGCAGACGAUGAGAAdTdT 636 s 322 GGAAGGCACUUGGCAUCUCdTdT 637 as 340GAGAUGCCAAGUGCCUUCCdTdT 638 s 326 GGCACUUGGCAUCUCCCCAdTdT 639 as 344UGGGGAGAUGCCAAGUGCCdTdT 640 s 333 GGCAUCUCCCCAUUCCAUGdTdT 641 as 351AUGGAAUGGGGAGAUGCCTTdTdT 642 s 334 GCAUCUCCCCAUUCCAUGAdTdT 643 as 352UCAUGGAAUGGGGAGAUGCdTdT 644 s 335 CAUCUCCCCAUUCCAUGAGdTdT 645 as 353CUCAUGGAAUGGGGAGAUGdTdT 646 s 336 AUCUCCCCAUUCCAUGAGCdTdT 647 as 354GCUCAUGGAAUGGGGAGAUdTdT 648 s 338 CUCCCCAUUCCAUGAGCAUdTdT 649 as 356AUGCUCAUGGAAUGGGGAGdTdT 650 s 341 CCCAUUCCAUGAGCAUGCAdTdT 651 as 359UGCAUGCUCAUGGAAUGGGdTdT 652 s 347 CCAUGAGCAUGCAGAGGUGdTdT 653 as 365CACCUCUGCAUGCUCAUGGdTdT 654 s 352 AGCAUGCAGAGGUGGUAUUdTdT 655 as 370AAUACCACCUCUGCAUGCUdTdT 656 s 354 CAUGCAGAGGUGGUAUUCAdTdT 657 as 372UGAAUACCACCUCUGCAUGdTdT 658 s 355 AUGCAGAGGUGGUAUUCACdTdT 659 as 373GUGAAUACCACCUCUGCAUdTdT 660 s 362 GGUGGUAUUCACAGCCAACdTdT 661 as 380GUUGGCUGUGAAUACCACCdTdT 662 s 363 GUGGUAUUCACAGCCAACGdTdT 663 as 381CGUUGGCUGUGAAUACCACdTdT 664 s 364 UGGUAUUCACAGCCAACGAdTdT 665 as 382UCGUUGGCUGUGAAUACCAdTdT 666 s 365 GGUAUUCACAGCCAACGACdTdT 667 as 383GUCGUUGGCUGUGAAUACCdTdT 668 s 366 GUAUUCACAGCCAACGACUdTdT 669 as 384AGUCGUUGGCUGUGAAUACdTdT 670 s 367 UAUUCACAGCCAACGACUCdTdT 671 as 385GAGUCGUUGGCUGUGAAUAdTdT 672 s 370 UCACAGCCAACGACUCCGGdTdT 673 as 388CCGGAGUCGUUGGCUGUGAdTdT 674 s 390 CCCCGCCGCUACACCAUUGdTdT 675 as 408CAAUGGUGUAGCGGCGGGGdTdT 676 s 4 GAAGUCCACUCAUUCUUGGdTdT 677 as 22CCAAGAAUGAGUGGACUUCdTdT 678 s 412 CCCUGCUGAGCCCCUACUCdTdT 679 as 430GAGUAGGGGCUCAGCAGGGdTdT 680 s 417 CUGAGCCCCUACUCCUAUUdTdT 681 as 435AAUAGGAGUAGGGGCUCAGdTdT 682 s 418 UGAGCCCCUACUCCUAUUCdTdT 683 as 436GAAUAGGAGUAGGGGCUCAdTdT 684 s 422 CCCCUACUCCUAUUCCACCdTdT 685 as 440GGUGGAAUAGGAGUAGGGGdTdT 686 s 425 CUACUCCUAUUCCACCACGdTdT 687 as 443CGUGGUGGAAUAGGAGUAGdTdT 688 s 426 UACUCCUAUUCCACCACGGdTdT 689 as 444CCGUGGUGGAAUAGGAGUAdTdT 690 s 427 ACUCCUAUUCCACCACGGCdTdT 691 as 445GCCGUGGUGGAAUAGGAGUdTdT 692 s 429 UCCUAUUCCACCACGGCUGdTdT 693 as 447CAGCCGUGGUGGAAUAGGAdTdT 694 s 432 UAUUCCACCACGGCUGUCGdTdT 695 as 450CGACAGCCGUGGUGGAAUAdTdT 696 s 433 AUUCCACCACGGCUGUCGUdTdT 697 as 451ACGACAGCCGUGGUGGAAUdTdT 698 s 437 CACCACGGCUGUCGUCACCdTdT 699 as 455GGUGACGACAGCCGUGGUGdTdT 700 s 438 ACCACGGCUGUCGUCACCAdTdT 701 as 456UGGUGACGACAGCCGUGGUdTdT 702 s 439 CCACGGCUGUCGUCACCAAdTdT 703 as 457UUGGUGACGACAGCCGUGGdTdT 704 s 441 ACGGCUGUCGUCACCAAUCdTdT 705 as 459GAUUGGUGACGACAGCCGUdTdT 706 s 442 CGGCUGUCGUCACCAAUCCdTdT 707 as 460GGAUUGGUGACGACAGCCGdTdT 708 s 449 CGUCACCAAUCCCAAGGAAdTdT 709 as 467UUCCUUGGGAUUGGUGACGdTdT 710 s 455 CAAUCCCAAGGAAUGAGGGdTdT 711 as 473CCCUCAUUCCUUGGGAUUGdTdT 712 s 491 CCUGAAGGACGAGGGAUGGdTdT 713 as 509CCAUCCCUCGUCCUUCAGGdTdT 714 s 497 GGACGAGGGAUGGGAUUUCdTdT 715 as 515GAAAUCCCAUCCCUCGUCCdTdT 716 s 5 AAGUCCACUCAUUCUUGGCdTdT 717 as 23GCCAAGAAUGAGUGGACUUdTdT 718 s 508 GGGAUUUCAUGUAACCAAGdTdT 719 as 526CUUGGUUACAUGAAAUCCCdTdT 720 s 509 GGAUUUCAUGUAACCAAGAdTdT 721 as 527UCUUGGUUACAUGAAAUCCdTdT 722 s 514 UCAUGUAACCAAGAGUAUUdTdT 723 as 532AAUACUCUUGGUUACAUGAdTdT 724 s 516 AUGUAACCAAGAGUAUUCCdTdT 725 as 534GGAAUACUCUUGGUUACAUdTdT 726 s 517 UGUAACCAAGAGUAUUCCAdTdT 727 as 535UGGAAUACUCUUGGUUACAdTdT 728 s 518 GUAACCAAGAGUAUUCCAUdTdT 729 as 536AUGGAAUACUCUUGGUUACdTdT 730 s 54 UGCCUUGCUGGACUGGUAUdTdT 731 as 72AUACCAGUCCAGCAAGGCAdTdT 732 s 543 UAAAGCAGUGUUUUCACCUdTdT 733 as 561AGGUGAAAACACUGCUUUAdTdT 734 s 55 GCCUUGCUGGACUGGUAUUdTdT 735 as 73AAUACCAGUCCAGCAAGGCdTdT 736 s 551 UGUUUUCACCUCAUAUGCUdTdT 737 as 569AGCAUAUGAGGUGAAAACAdTdT 738 s 552 GUUUUCACCUCAUAUGCUAdTdT 739 as 570UAGCAUAUGAGGUGAAAACdTdT 740 s 553 UUUUCACCUCAUAUGCUAUdTdT 741 as 571AUAGCAUAUGAGGUGAAAAdTdT 742 s 555 UUCACCUCAUAUGCUAUGUdTdT 743 as 573ACAUAGCAUAUGAGGUGAAdTdT 744 s 557 CACCUCAUAUGCUAUGUUAdTdT 745 as 575UAACAUAGCAUAUGAGGUGdTdT 746 s 56 CCUUGCUGGACUGGUAUUUdTdT 747 as 74AAAUACCAGUCCAGCAAGGdTdT 748 s 563 AUAUGCUAUGUUAGAAGUCdTdT 749 as 581GACUUCUAACAUAGCAUAUdTdT 750 s 564 UAUGCUAUGUUAGAAGUCCdTdT 751 as 582GGACUUCUAACAUAGCAUAdTdT 752 s 566 UGCUAUGUUAGAAGUCCAGdTdT 753 as 584CUGGACUUCUAACAUAGCAdTdT 754 s 57 CUUGCUGGACUGGUAUUUGdTdT 755 as 75CAAAUACCAGUCCAGCAAGdTdT 756 s 578 AGUCCAGGCAGAGACAAUAdTdT 757 as 596AUUGUCUCUGCCUGGACUTTdTdT 758 s 580 UCCAGGCAGAGACAAUAAAdTdT 759 as 598UUUAUUGUCUCUGCCUGGAdTdT 760 s 607 GUGAAAGGCACUUUUCAUUdTdT 761 as 625AAUGAAAAGUGCCUUUCACdTdT 762 s 62 UGGACUGGUAUUUGUGUCUdTdT 763 as 80AGACACAAAUACCAGUCCAdTdT 764 s 77 GUCUGAGGCUGGCCCUACGdTdT 765 as 95CGUAGGGCCAGCCUCAGACdTdT 766 s 79 CUGAGGCUGGCCCUACGGGdTdT 767 as 97CCCGUAGGGCCAGCCUCAGdTdT 768 s 81 GAGGCUGGCCCUACGGGCAdTdT 769 as 99UGCCCGUAGGGCCAGCCUCdTdT 770 s 82 AGGCUGGCCCUACGGGCACdTdT 771 as 100GUGCCCGUAGGGCCAGCCUdTdT 772 s 84 GCUGGCCCUACGGGCACCGdTdT 773 as 102CGGUGCCCGUAGGGCCAGCdTdT 774 s 85 CUGGCCCUACGGGCACCGGdTdT 775 as 103CCGGUGCCCGUAGGGCCAGdTdT 776 s 87 GGCCCUACGGGCACCGGUGdTdT 777 as 105CACCGGUGCCCGUAGGGCCdTdT 778 s 9 CCACUCAUUCUUGGCAGGAdTdT 779 as 27UCCUGCCAAGAAUGAGUGGdTdT 780 s 90 CCUACGGGCACCGGUGAAUdTdT 781 as 108AUUCACCGGUGCCCGUAGGdTdT 782 s 91 CUACGGGCACCGGUGAAUCdTdT 783 as 109GAUUCACCGGUGCCCGUAGdTdT 784 s 92 UACGGGCACCGGUGAAUCCdTdT 785 as 110GGAUUCACCGGUGCCCGUAdTdT 786 s 93 ACGGGCACCGGUGAAUCCAdTdT 787 as 111UGGAUUCACCGGUGCCCGUdTdT 788 s 97 GCACCGGUGAAUCCAAGUGdTdT 789 as 115CACUUGGAUUCACCGGUGCdTdT 790 s 98 CACCGGUGAAUCCAAGUGUdTdT 791 as 116ACACUUGGAUUCACCGGUGdTdT 792 s 167 UGUGGCCAUGCAUGUGUUCdTdT 793 as 185GAACACAUGCAUGGCCACAdTdT 794 s 168 GUGGCCAUGCAUGUGUUCAdTdT 795 as 186UGAACACAUGCAUGGCCACdTdT 796 s 171 GCCAUGCAUGUGUUCAGAAdTdT 797 as 189UUCUGAACACAUGCAUGGCdTdT 798 s 432 UAUUCCACCACGGCUGUCAdTdT 799 as 449UGACAGCCGUGGUGGAAUAdTdT 800 s 447 GUCAUCACCAAUCCCAAGGdTdT 801 as 465CCUUGGGAUUGGUGAUGACdTdT 802 s 115 GUCCUCUGAUGGUCAAAGUdTdT 803 as 133ACUUUGACCAUCAGAGGACdTdT 804 s 122 GAUGGUCAAAGUUCUAGAUdTdT 805 as 140AUCUAGAACUUUGACCAUCdTdT 806 s 139 AUGCUGUCCGAGGCAGUCCdTdT 807 as 157GGACUGCCUCGGACAGCAUdTdT 808 s 172 CCGUGCAUGUGUUCAGAAAdTdT 809 as 190UUUCUGAACACAUGCACGGdTdT 810 s 238 AGUCUGGAGAGCUGCAUGGdTdT 811 as 256CCAUGCAGCUCUCCAGACUdTdT 812 s 252 CAUGGGCUCACAACUGAGGdTdT 813 as 270CCUCAGUUGUGAGCCCAUGdTdT 814 s 33 UCUCAUCGUCUGCUCCUCCdTdT 815 as 51GGAGGAGCAGACGAUGAGAdTdT 816 s 340 CCCCAUUCCAUGAGCAUGCdTdT 817 as 358GCAUGCUCAUGGAAUGGGGdTdT 818 s 421 GCCCCUACUCCUAUUCCACdTdT 819 as 439GUGGAAUAGGAGUAGGGGCdTdT 820 s 431 CUAUUCCACCACGGCUGUCdTdT 821 as 449GACAGCCGUGGUGGAAUAGdTdT 822 s 440 CACGGCUGUCGUCACCAAUdTdT 823 as 458AUUGGUGACGACAGCCGUGdTdT 824 s 496 AGGACGAGGGAUGGGAUUUdTdT 825 as 514AAAUCCCAUCCCUCGUCCUdTdT 826 s 556 UCACCUCAUAUGCUAUGUUdTdT 827 as 574AACAUAGCAUAUGAGGUGAdTdT 828 s 559 CCUCAUAUGCUAUGUUAGAdTdT 829 as 577UCUAACAUAGCAUAUGAGGdTdT 830 s 570 AUGUUAGAAGUCCAGGCAGdTdT 831 as 588CUGCCUGGACUUCUAACAUdTdT 832 s 78 UCUGAGGCUGGCCCUACGGdTdT 833 as 96CCGUAGGGCCAGCCUCAGAdTdT 834 s 87 GGCCCUACGGGCACCGGUGdTdT 835 as 105CACCGGUGCCCGUAGGGCCdTdT 836 s 95 GGGCACCGGUGAAUCCAAGdTdT 837 as 113CUUGGAUUCACCGGUGCCCdTdT 838 s 167 CCAUGCAUGUGUUCAGAAAdTdT 839 as 185UUUCUGAACACAUGCAUGGdTdT 840 Strand: s = sense; as = antisense; Position:position of 5′ base on transcript (NM_000371.2, SEQ ID NO: 1329)

TABLE 4Chemically modified sense and antisense strand sequences of human TTRdsRNAs Strand Oligo # Position Sequence(5′ to 3′) SEQ ID NO: s A-32153100 ccGGuGAAuccAAGuGuccdTdT 841 as A-32154 118 GGAcACUUGGAUUcACCGGdTdT842 s A-32155 11 AcucAuucuuGGcAGGAuGdTdT 843 as A-32156 29cAUCCUGCcAAGAAUGAGUdTdT 844 s A-32157 111 AAGuGuccucuGAuGGucAdTdT 845 asA-32158 129 UGACcAUcAGAGGAcACUUdTdT 846 s A-32163 13ucAuucuuGGcAGGAuGGcdTdT 847 as A-32164 31 GCcAUCCUGCcAAGAAUGAdTdT 848 sA-32165 130 AAGuucuAGAuGcuGuccGdTdT 849 as A-32166 148CGGAcAGcAUCuAGAACUUdTdT 850 s A-32167 132 GuucuAGAuGcuGuccGAGdTdT 851 asA-32168 150 CUCGGAcAGcAUCuAGAACdTdT 852 s A-32169 135cuAGAuGcuGuccGAGGcAdTdT 853 as A-32170 153 UGCCUCGGAcAGcAUCuAGdTdT 854 sA-32171 138 GAuGcuGuccGAGGcAGucdTdT 855 as A-32172 156GACUGCCUCGGAcAGcAUCdTdT 856 s A-32175 14 cAuucuuGGcAGGAuGGcudTdT 857 asA-32176 32 AGCcAUCCUGCcAAGAAUGdTdT 858 s A-32177 140uGcuGuccGAGGcAGuccudTdT 859 as A-32178 158 AGGACUGCCUCGGAcAGcAdTdT 860 sA-32179 146 ccGAGGcAGuccuGccAucdTdT 861 as A-32180 164GAUGGcAGGACUGCCUCGGdTdT 862 s A-32181 152 cAGuccuGccAucAAuGuGdTdT 863 asA-32182 170 cAcAUUGAUGGcAGGACUGdTdT 864 s A-32183 164cAAuGuGGccGuGcAuGuGdTdT 865 as A-32184 182 cAcAUGcACGGCcAcAUUGdTdT 866 sA-32187 178 AuGuGuucAGAAAGGcuGcdTdT 867 as A-32188 196GcAGCCUUUCUGAAcAcAUdTdT 868 s A-32189 2 cAGAAGuccAcucAuucuudTdT 869 asA-32190 20 AAGAAUGAGUGGACUUCUGdTdT 870 s A-32191 21GGcAGGAuGGcuucucAucdTdT 871 as A-32192 39 GAUGAGAAGCcAUCCUGCCdTdT 872 sA-32193 210 GAGccAuuuGccucuGGGAdTdT 873 as A-32194 228UCCcAGAGGcAAAUGGCUCdTdT 874 s A-32195 23 cAGGAuGGcuucucAucGudTdT 875 asA-32196 41 ACGAUGAGAAGCcAUCCUGdTdT 876 s A-32199 24AGGAuGGcuucucAucGucdTdT 877 as A-32200 42 GACGAUGAGAAGCcAUCCUdTdT 878 sA-32201 245 AGAGcuGcAuGGGcucAcAdTdT 879 as A-32202 263UGUGAGCCcAUGcAGCUCUdTdT 880 s A-32203 248 GcuGcAuGGGcucAcAAcudTdT 881 asA-32204 266 AGUUGUGAGCCcAUGcAGCdTdT 882 s A-32205 25GGAuGGcuucucAucGucudTdT 883 as A-32206 43 AGACGAUGAGAAGCcAUCCdTdT 884 sA-32207 251 GcAuGGGcucAcAAcuGAGdTdT 885 as A-32208 269CUcAGUUGUGAGCCcAUGCdTdT 886 s A-32211 253 AuGGGcucAcAAcuGAGGAdTdT 887 asA-32212 271 UCCUcAGUUGUGAGCCcAUdTdT 888 s A-32213 254uGGGcucAcAAcuGAGGAGdTdT 889 as A-32214 272 CUCCUcAGUUGUGAGCCcAdTdT 890 sA-32215 270 GAGGAAuuuGuAGAAGGGAdTdT 891 as A-32216 288UCCCUUCuAcAAAUUCCUCdTdT 892 s A-32217 276 uuuGuAGAAGGGAuAuAcAdTdT 893 asA-32218 294 UGuAuAUCCCUUCuAcAAAdTdT 894 s A-32219 277uuGuAGAAGGGAuAuAcAAdTdT 895 as A-32220 295 UUGuAuAUCCCUUCuAcAAdTdT 896 sA-32221 278 uGuAGAAGGGAuAuAcAAAdTdT 897 as A-32222 296UUUGuAuAUCCCUUCuAcAdTdT 898 s A-32223 281 AGAAGGGAuAuAcAAAGuGdTdT 899 asA-32224 299 cACUUUGuAuAUCCCUUCUdTdT 900 s A-32225 295AAGuGGAAAuAGAcAccAAdTdT 901 as A-32226 313 UUGGUGUCuAUUUCcACUUdTdT 902 sA-32227 299 GGAAAuAGAcAccAAAucudTdT 903 as A-32228 317AGAUUUGGUGUCuAUUUCCdTdT 904 s A-32229 300 GAAAuAGAcAccAAAucuudTdT 905 asA-32230 318 AAGAUUUGGUGUCuAUUUCdTdT 906 s A-32231 303AuAGAcAccAAAucuuAcudTdT 907 as A-32232 321 AGuAAGAUUUGGUGUCuAUdTdT 908 sA-32233 304 uAGAcAccAAAucuuAcuGdTdT 909 as A-32234 322cAGuAAGAUUUGGUGUCuAdTdT 910 s A-32235 305 AGAcAccAAAucuuAcuGGdTdT 911 asA-32236 323 CcAGuAAGAUUUGGUGUCUdTdT 912 s A-32237 317uuAcuGGAAGGcAcuuGGcdTdT 913 as A-32238 335 GCcAAGUGCCUUCcAGuAAdTdT 914 sA-32239 32 uucucAucGucuGcuccucdTdT 915 as A-32240 50GAGGAGcAGACGAUGAGAAdTdT 916 s A-32241 322 GGAAGGcAcuuGGcAucucdTdT 917 asA-32242 340 GAGAUGCcAAGUGCCUUCCdTdT 918 s A-32243 326GGcAcuuGGcAucuccccAdTdT 919 as A-32244 344 UGGGGAGAUGCcAAGUGCCdTdT 920 sA-32247 333 GGcAucuccccAuuccAuGdTdT 921 as A-32248 351cAUGGAAUGGGGAGAUGCCdTdT 922 s A-32249 334 GcAucuccccAuuccAuGAdTdT 923 asA-32250 352 UcAUGGAAUGGGGAGAUGCdTdT 924 s A-32251 335cAucuccccAuuccAuGAGdTdT 925 as A-32252 353 CUcAUGGAAUGGGGAGAUGdTdT 926 sA-32253 336 AucuccccAuuccAuGAGcdTdT 927 as A-32254 354GCUcAUGGAAUGGGGAGAUdTdT 928 s A-32255 338 cuccccAuuccAuGAGcAudTdT 929 asA-32256 356 AUGCUcAUGGAAUGGGGAGdTdT 930 s A-32259 341cccAuuccAuGAGcAuGcAdTdT 931 as A-32260 359 UGcAUGCUcAUGGAAUGGGdTdT 932 sA-32261 347 ccAuGAGcAuGcAGAGGuGdTdT 933 as A-32262 365cACCUCUGcAUGCUcAUGGdTdT 934 s A-32263 352 AGcAuGcAGAGGuGGuAuudTdT 935 asA-32264 370 AAuACcACCUCUGcAUGCUdTdT 936 s A-32265 354cAuGcAGAGGuGGuAuucAdTdT 937 as A-32266 372 UGAAuACcACCUCUGcAUGdTdT 938 sA-32267 355 AuGcAGAGGuGGuAuucAcdTdT 939 as A-32268 373GUGAAuACcACCUCUGcAUdTdT 940 s A-32269 362 GGuGGuAuucAcAGccAAcdTdT 941 asA-32270 380 GUUGGCUGUGAAuACcACCdTdT 942 s A-32271 363GuGGuAuucAcAGccAAcGdTdT 943 as A-32272 381 CGUUGGCUGUGAAuACcACdTdT 944 sA-32273 364 uGGuAuucAcAGccAAcGAdTdT 945 as A-32274 382UCGUUGGCUGUGAAuACcAdTdT 946 s A-32275 365 GGuAuucAcAGccAAcGAcdTdT 947 asA-32276 383 GUCGUUGGCUGUGAAuACCdTdT 948 s A-32277 366GuAuucAcAGccAAcGAcudTdT 949 as A-32278 384 AGUCGUUGGCUGUGAAuACdTdT 950 sA-32279 367 uAuucAcAGccAAcGAcucdTdT 951 as A-32280 385GAGUCGUUGGCUGUGAAuAdTdT 952 s A-32281 370 ucAcAGccAAcGAcuccGGdTdT 953 asA-32282 388 CCGGAGUCGUUGGCUGUGAdTdT 954 s A-32283 390ccccGccGcuAcAccAuuGdTdT 955 as A-32284 408 cAAUGGUGuAGCGGCGGGGdTdT 956 sA-32285 4 GAAGuccAcucAuucuuGGdTdT 957 as A-32286 22CcAAGAAUGAGUGGACUUCdTdT 958 s A-32287 412 cccuGcuGAGccccuAcucdTdT 959 asA-32288 430 GAGuAGGGGCUcAGcAGGGdTdT 960 s A-32289 417cuGAGccccuAcuccuAuudTdT 961 as A-32290 435 AAuAGGAGuAGGGGCUcAGdTdT 962 sA-32291 418 uGAGccccuAcuccuAuucdTdT 963 as A-32292 436GAAuAGGAGuAGGGGCUcAdTdT 964 s A-32295 422 ccccuAcuccuAuuccAccdTdT 965 asA-32296 440 GGUGGAAuAGGAGuAGGGGdTdT 966 s A-32297 425cuAcuccuAuuccAccAcGdTdT 967 as A-32298 443 CGUGGUGGAAuAGGAGuAGdTdT 968 sA-32299 426 uAcuccuAuuccAccAcGGdTdT 969 as A-32300 444CCGUGGUGGAAuAGGAGuAdTdT 970 s A-32301 427 AcuccuAuuccAccAcGGcdTdT 971 asA-32302 445 GCCGUGGUGGAAuAGGAGUdTdT 972 s A-32303 429uccuAuuccAccAcGGcuGdTdT 973 as A-32304 447 cAGCCGUGGUGGAAuAGGAdTdT 974 sA-32307 432 uAuuccAccAcGGcuGucGdTdT 975 as A-32308 450CGAcAGCCGUGGUGGAAuAdTdT 976 s A-32309 433 AuuccAccAcGGcuGucGudTdT 977 asA-32310 451 ACGAcAGCCGUGGUGGAAUdTdT 978 s A-32311 437cAccAcGGcuGucGucAccdTdT 979 as A-32312 455 GGUGACGAcAGCCGUGGUGdTdT 980 sA-32313 438 AccAcGGcuGucGucAccAdTdT 981 as A-32314 456UGGUGACGAcAGCCGUGGUdTdT 982 s A-32315 439 ccAcGGcuGucGucAccAAdTdT 983 asA-32316 457 UUGGUGACGAcAGCCGUGGdTdT 984 s A-32319 441AcGGcuGucGucAccAAucdTdT 985 as A-32320 459 GAUUGGUGACGAcAGCCGUdTdT 986 sA-32321 442 cGGcuGucGucAccAAuccdTdT 987 as A-32322 460GGAUUGGUGACGAcAGCCGdTdT 988 s A-32323 449 cGucAccAAucccAAGGAAdTdT 989 asA-32324 467 UUCCUUGGGAUUGGUGACGdTdT 990 s A-32325 455cAAucccAAGGAAuGAGGGdTdT 991 as A-32326 473 CCCUcAUUCCUUGGGAUUGdTdT 992 sA-32327 491 ccuGAAGGAcGAGGGAuGGdTdT 993 as A-32328 509CcAUCCCUCGUCCUUcAGGdTdT 994 s A-32331 497 GGAcGAGGGAuGGGAuuucdTdT 995 asA-32332 515 GAAAUCCcAUCCCUCGUCCdTdT 996 s A-32333 5AAGuccAcucAuucuuGGcdTdT 997 as A-32334 23 GCcAAGAAUGAGUGGACUUdTdT 998 sA-32335 508 GGGAuuucAuGuAAccAAGdTdT 999 as A-32336 526CUUGGUuAcAUGAAAUCCCdTdT 1000 s A-32337 509 GGAuuucAuGuAAccAAGAdTdT 1001as A-32338 527 UCUUGGUuAcAUGAAAUCCdTdT 1002 s A-32339 514ucAuGuAAccAAGAGuAuudTdT 1003 as A-32340 532 AAuACUCUUGGUuAcAUGAdTdT 1004s A-32341 516 AuGuAAccAAGAGuAuuccdTdT 1005 as A-32342 534GGAAuACUCUUGGUuAcAUdTdT 1006 s A-32343 517 uGuAAccAAGAGuAuuccAdTdT 1007as A-32344 535 UGGAAuACUCUUGGUuAcAdTdT 1008 s A-32345 518GuAAccAAGAGuAuuccAudTdT 1009 as A-32346 536 AUGGAAuACUCUUGGUuACdTdT 1010s A-32347 54 uGccuuGcuGGAcuGGuAudTdT 1011 as A-32348 72AuACcAGUCcAGcAAGGcAdTdT 1012 s A-32349 543 uAAAGcAGuGuuuucAccudTdT 1013as A-32350 561 AGGUGAAAAcACUGCUUuAdTdT 1014 s A-32351 55GccuuGcuGGAcuGGuAuudTdT 1015 as A-32352 73 AAuACcAGUCcAGcAAGGCdTdT 1016s A-32353 551 uGuuuucAccucAuAuGcudTdT 1017 as A-32354 569AGcAuAUGAGGUGAAAAcAdTdT 1018 s A-32355 552 GuuuucAccucAuAuGcuAdTdT 1019as A-32356 570 uAGcAuAUGAGGUGAAAACdTdT 1020 s A-32357 553uuuucAccucAuAuGcuAudTdT 1021 as A-32358 571 AuAGcAuAUGAGGUGAAAAdTdT 1022s A-32359 555 uucAccucAuAuGcuAuGudTdT 1023 as A-32360 573AcAuAGcAuAUGAGGUGAAdTdT 1024 s A-32363 557 cAccucAuAuGcuAuGuuAdTdT 1025as A-32364 575 uAAcAuAGcAuAUGAGGUGdTdT 1026 s A-32367 56ccuuGcuGGAcuGGuAuuudTdT 1027 as A-32368 74 AAAuACcAGUCcAGcAAGGdTdT 1028s A-32369 563 AuAuGcuAuGuuAGAAGucdTdT 1029 as A-32370 581GACUUCuAAcAuAGcAuAUdTdT 1030 s A-32371 564 uAuGcuAuGuuAGAAGuccdTdT 1031as A-32372 582 GGACUUCuAAcAuAGcAuAdTdT 1032 s A-32373 566uGcuAuGuuAGAAGuccAGdTdT 1033 as A-32374 584 CUGGACUUCuAAcAuAGcAdTdT 1034s A-32375 57 cuuGcuGGAcuGGuAuuuGdTdT 1035 as A-32376 75cAAAuACcAGUCcAGcAAGdTdT 1036 s A-32379 578 AGuccAGGcAGAGAcAAuAdTdT 1037as A-32380 596 uAUUGUCUCUGCCUGGACUdTdT 1038 s A-32381 580uccAGGcAGAGAcAAuAAAdTdT 1039 as A-32382 598 UUuAUUGUCUCUGCCUGGAdTdT 1040s A-32383 607 GuGAAAGGcAcuuuucAuudTdT 1041 as A-32384 625AAUGAAAAGUGCCUUUcACdTdT 1042 s A-32385 62 uGGAcuGGuAuuuGuGucudTdT 1043as A-32386 80 AGAcAcAAAuACcAGUCcAdTdT 1044 s A-32387 77GucuGAGGcuGGcccuAcGdTdT 1045 as A-32388 95 CGuAGGGCcAGCCUcAGACdTdT 1046s A-32391 79 cuGAGGcuGGcccuAcGGGdTdT 1047 as A-32392 97CCCGuAGGGCcAGCCUcAGdTdT 1048 s A-32393 81 GAGGcuGGcccuAcGGGcAdTdT 1049as A-32394 99 UGCCCGuAGGGCcAGCCUCdTdT 1050 s A-32395 82AGGcuGGcccuAcGGGcAcdTdT 1051 as A-32396 100 GUGCCCGuAGGGCcAGCCUdTdT 1052s A-32397 84 GcuGGcccuAcGGGcAccGdTdT 1053 as A-32398 102CGGUGCCCGuAGGGCcAGCdTdT 1054 s A-32399 85 cuGGcccuAcGGGcAccGGdTdT 1055as A-32400 103 CCGGUGCCCGuAGGGCcAGdTdT 1056 s A-32401 87GGcccuAcGGGcAccGGuGdTdT 1057 as A-32402 105 cACCGGUGCCCGuAGGGCCdTdT 1058s A-32403 9 ccAcucAuucuuGGcAGGAdTdT 1059 as A-32404 27UCCUGCcAAGAAUGAGUGGdTdT 1060 s A-32405 90 ccuAcGGGcAccGGuGAAudTdT 1061as A-32406 108 AUUcACCGGUGCCCGuAGGdTdT 1062 s A-32407 91cuAcGGGcAccGGuGAAucdTdT 1063 as A-32408 109 GAUUcACCGGUGCCCGuAGdTdT 1064s A-32409 92 uAcGGGcAccGGuGAAuccdTdT 1065 as A-32410 110GGAUUcACCGGUGCCCGuAdTdT 1066 s A-32411 93 AcGGGcAccGGuGAAuccAdTdT 1067as A-32412 111 UGGAUUcACCGGUGCCCGUdTdT 1068 s A-32415 97GcAccGGuGAAuccAAGuGdTdT 1069 as A-32416 115 cACUUGGAUUcACCGGUGCdTdT 1070s A-32417 98 cAccGGuGAAuccAAGuGudTdT 1071 as A-32418 116AcACUUGGAUUcACCGGUGdTdT 1072 s A-32419 167 uGuGGccAuGcAuGuGuucdTdT 1073as A-32420 185 GAAcAcAUGcAUGGCcAcAdTdT 1074 s A-32421 168GuGGccAuGcAuGuGuucAdTdT 1075 as A-32422 186 UGAAcAcAUGcAUGGCcACdTdT 1076s A-32423 171 GccAuGcAuGuGuucAGAAdTdT 1077 as A-32424 189UUCUGAAcAcAUGcAUGGCdTdT 1078 s A-32427 432 uAuuccAccAcGGcuGucAdTdT 1079as A-32428 449 UGAcAGCCGUGGUGGAAuAdTdT 1080 s A-32429 447GucAucAccAAucccAAGGdTdT 1081 as A-32430 465 CCUUGGGAUUGGUGAUGACdTdT 1082s A-32159 115 GuccucuGAuGGucAAAGudTdT 1083 as A-32160 133ACUUUGACcAUcAGAGGACdTdT 1084 s A-32161 122 GAuGGucAAAGuucuAGAudTdT 1085as A-32162 140 AUCuAGAACUUUGACcAUCdTdT 1086 s A-32173 139AuGcuGuccGAGGcAGuccdTdT 1087 as A-32174 157 GGACUGCCUCGGAcAGcAUdTdT 1088s A-32185 172 ccGuGcAuGuGuucAGAAAdTdT 1089 as A-32186 190UUUCUGAAcAcAUGcACGGdTdT 1090 s A-32197 238 AGucuGGAGAGcuGcAuGGdTdT 1091as A-32198 256 CcAUGcAGCUCUCcAGACUdTdT 1092 s A-32209 252cAuGGGcucAcAAcuGAGGdTdT 1093 as A-32210 270 CCUcAGUUGUGAGCCcAUGdTdT 1094s A-32245 33 ucucAucGucuGcuccuccdTdT 1095 as A-32246 51GGAGGAGcAGACGAUGAGAdTdT 1096 s A-32257 340 ccccAuuccAuGAGcAuGcdTdT 1097as A-32258 358 GcAUGCUcAUGGAAUGGGGdTdT 1098 s A-32293 421GccccuAcuccuAuuccAcdTdT 1099 as A-32294 439 GUGGAAuAGGAGuAGGGGCdTdT 1100s A-32305 431 cuAuuccAccAcGGcuGucdTdT 1101 as A-32306 449GAcAGCCGUGGUGGAAuAGdTdT 1102 s A-32317 440 cAcGGcuGucGucAccAAudTdT 1103as A-32318 458 AUUGGUGACGAcAGCCGUGdTdT 1104 s A-32329 496AGGAcGAGGGAuGGGAuuudTdT 1105 as A-32330 514 AAAUCCcAUCCCUCGUCCUdTdT 1106s A-32361 556 ucAccucAuAuGcuAuGuudTdT 1107 as A-32362 574AAcAuAGcAuAUGAGGUGAdTdT 1108 s A-32365 559 ccucAuAuGcuAuGuuAGAdTdT 1109as A-32366 577 UCuAAcAuAGcAuAUGAGGdTdT 1110 s A-32377 570AuGuuAGAAGuccAGGcAGdTdT 1111 as A-32378 588 CUGCCUGGACUUCuAAcAUdTdT 1112s A-32389 78 ucuGAGGcuGGcccuAcGGdTdT 1113 as A-32390 96CCGuAGGGCcAGCCUcAGAdTdT 1114 s A-32401 87 GGcccuAcGGGcAccGGuGdTdT 1115as A-32402 105 cACCGGUGCCCGuAGGGCCdTdT 1116 s A-32413 95GGGcAccGGuGAAuccAAGdTdT 1117 as A-32414 113 CUUGGAUUcACCGGUGCCCdTdT 1118s A-32425 167 ccAuGcAuGuGuucAGAAAdTdT 1119 as A-32426 185UUUCUGAAcAcAUGcAUGGdTdT 1120 See Table 2 for duplex #. Strand: s =sense; as = antisense; Position: position of 5′ base ontranscript(NM_000371.2, SEQ ID NO: 1329)

TABLE 5 Identification numbers for rat TTR dsRNAs See Table 7 forsequences. Duplex # Sense Oligo # Antisense Oligo # AD-18529 A-32745A-32746 AD-18530 A-32747 A-32748 AD-18531 A-32749 A-32750 AD-18532A-32751 A-32752 AD-18533 A-32753 A-32754 AD-18534 A-32755 A-32756AD-18535 A-32757 A-32758 AD-18536 A-32759 A-32760 AD-18537 A-32761A-32762 AD-18538 A-32763 A-32764 AD-18539 A-32159 A-32160 AD-18540A-32765 A-32766 AD-18541 A-32767 A-32768 AD-18542 A-32769 A-32770AD-18543 A-32771 A-32772 AD-18544 A-32773 A-32774 AD-18545 A-32775A-32776 AD-18546 A-32777 A-32778 AD-18547 A-32779 A-32780 AD-18548A-32781 A-32782 AD-18549 A-32783 A-32784 AD-18550 A-32785 A-32786AD-18551 A-32787 A-32788 AD-18552 A-32791 A-32792 AD-18553 A-32793A-32794 AD-18554 A-32795 A-32796

TABLE 6A Sense and antisense strand sequences for rat TTR dsRNAsSequence with 3′ SEQ ID dinucleotide overhang SEQ ID Strand PositionSequence (5′ to 3′) NO: (5′ to 3′)  NO: s 115 GUCCUCUGAUGGUCAAAGU 1121GUCCUCUGAUGGUCAAAGUNN 1173 as 133 ACUUUGACCAUCAGAGGAC 1122ACUUUGACCAUCAGAGGACNN 1174 s 537 UUCUUGCUCUAUAAACCGU 1123UUCUUGCUCUAUAAACCGUNN 1175 as 555 ACGGUUUAUAGAGCAAGAA 1124ACGGUUUAUAGAGCAAGAANN 1176 s 543 CUCUAUAAACCGUGUUAGC 1125CUCUAUAAACCGUGUUAGCNN 1177 as 561 GCUAACACGGUUUAUAGAG 1126GCUAACACGGUUUAUAGAGNN 1178 s 392 UCGCCACUACACCAUCGCA 1127UCGCCACUACACCAUCGCANN 1179 as 410 UGCGAUGGUGUAGUGGCGA 1128UGCGAUGGUGUAGUGGCGANN 1180 s 538 UCUUGCUCUAUAAACCGUG 1129UCUUGCUCUAUAAACCGUGNN 1181 as 556 CACGGUUUAUAGAGCAAGA 1130CACGGUUUAUAGAGCAAGANN 1182 s 541 UGCUCUAUAAACCGUGUUA 1131UGCUCUAUAAACCGUGUUANN 1183 as 559 UAACACGGUUUAUAGAGCA 1132UAACACGGUUUAUAGAGCANN 1184 s 532 CAGUGUUCUUGCUCUAUAA 1133CAGUGUUCUUGCUCUAUAANN 1185 as 550 UUAUAGAGCAAGAACACUG 1134UUAUAGAGCAAGAACACUGNN 1186 s 542 GCUCUAUAAACCGUGUUAG 1135GCUCUAUAAACCGUGUUAGNN 1187 as 560 CUAACACGGUUUAUAGAGC 1136CUAACACGGUUUAUAGAGCNN 1188 s 134 CCUGGAUGCUGUCCGAGGC 1137CCUGGAUGCUGUCCGAGGCNN 1189 as 152 GCCUCGGACAGCAUCCAGG 1138GCCUCGGACAGCAUCCAGGNN 1190 s 119 UCUGAUGGUCAAAGUCCUG 1139UCUGAUGGUCAAAGUCCUGNN 1191 as 137 CAGGACUUUGACCAUCAGA 1140CAGGACUUUGACCAUCAGANN 1192 s 241 CUGGAGAGCUGCACGGGCU 1141CUGGAGAGCUGCACGGGCUNN 1193 as 259 AGCCCGUGCAGCUCUCCAG 1142AGCCCGUGCAGCUCUCCAGNN 1194 s 544 UCUAUAAACCGUGUUAGCA 1143UCUAUAAACCGUGUUAGCANN 1195 as 562 UGCUAACACGGUUUAUAGA 1144UGCUAACACGGUUUAUAGANN 1196 s 530 AACAGUGUUCUUGCUCUAU 1145AACAGUGUUCUUGCUCUAUNN 1197 as 548 AUAGAGCAAGAACACUGUU 1146AUAGAGCAAGAACACUGUUNN 1198 s 118 CUCUGAUGGUCAAAGUCCU 1147CUCUGAUGGUCAAAGUCCUNN 1199 as 136 AGGACUUUGACCAUCAGAG 1148AGGACUUUGACCAUCAGAGNN 1200 s 140 UGCUGUCCGAGGCAGCCCU 1149UGCUGUCCGAGGCAGCCCUNN 1201 as 158 AGGGCUGCCUCGGACAGCA 1150AGGGCUGCCUCGGACAGCANN 1202 s 239 GUCUGGAGAGCUGCACGGG 1151GUCUGGAGAGCUGCACGGGNN 1203 as 257 CCCGUGCAGCUCUCCAGAC 1152CCCGUGCAGCUCUCCAGACNN 1204 s 531 ACAGUGUUCUUGCUCUAUA 1153ACAGUGUUCUUGCUCUAUANN 1205 as 549 UAUAGAGCAAGAACACUGU 1154UAUAGAGCAAGAACACUGUNN 1206 s 117 CCUCUGAUGGUCAAAGUCC 1155CCUCUGAUGGUCAAAGUCCNN 1207 as 135 GGACUUUGACCAUCAGAGG 1156GGACUUUGACCAUCAGAGGNN 1208 s 131 AGUCCUGGAUGCUGUCCGA 1157AGUCCUGGAUGCUGUCCGANN 1209 as 149 UCGGACAGCAUCCAGGACU 1158UCGGACAGCAUCCAGGACUNN 1210 s 217 UUGCCUCUGGGAAGACCGC 1159UUGCCUCUGGGAAGACCGCNN 1211 as 235 GCGGUCUUCCCAGAGGCAA 1160GCGGUCUUCCCAGAGGCAANN 1212 s 242 UGGAGAGCUGCACGGGCUC 1161UGGAGAGCUGCACGGGCUCNN 1213 as 260 GAGCCCGUGCAGCUCUCCA 1162GAGCCCGUGCAGCUCUCCANN 1214 s 244 GAGAGCUGCACGGGCUCAC 1163GAGAGCUGCACGGGCUCACNN 1215 as 262 GUGAGCCCGUGCAGCUCUC 1164GUGAGCCCGUGCAGCUCUCNN 1216 s 246 GAGCUGCACGGGCUCACCA 1165GAGCUGCACGGGCUCACCANN 1217 as 264 UGGUGAGCCCGUGCAGCUC 1166UGGUGAGCCCGUGCAGCUCNN 1218 s 399 UACACCAUCGCAGCCCUGC 1167UACACCAUCGCAGCCCUGCNN 1219 as 417 GCAGGGCUGCGAUGGUGUA 1168GCAGGGCUGCGAUGGUGUANN 1220 s 132 GUCCUGGAUGCUGUCCGAG 1169GUCCUGGAUGCUGUCCGAGNN 1221 as 150 CUCGGACAGCAUCCAGGAC 1170CUCGGACAGCAUCCAGGACNN 1222 s 245 AGAGCUGCACGGGCUCACC 1171AGAGCUGCACGGGCUCACCNN 1223 as 263 GGUGAGCCCGUGCAGCUCU 1172GGUGAGCCCGUGCAGCUCUNN 1224 Strand: s = sense; as = antisense; Position:position of 5′ base on transcript (NM_012681.1, SEQ ID NO: 1330)

TABLE 6B Sense and antisense strand sequences  for rat TTR dsRNAsSequence with SEQ Posi- 3′deoxythimidine ID Strand tion overhang (5′to 3′) NO: s 115 GUCCUCUGAUGGUCAAAGUdTdT 1225 as 133ACUUUGACCAUCAGAGGACdTdT 1226 s 537 UUCUUGCUCUAUAAACCGUdTdT 1227 as 555ACGGUUUAUAGAGCAAGAAdTdT 1228 s 543 CUCUAUAAACCGUGUUAGCdTdT 1229 as 561GCUAACACGGUUUAUAGAGdTdT 1230 s 392 UCGCCACUACACCAUCGCAdTdT 1231 as 410UGCGAUGGUGUAGUGGCGAdTdT 1232 s 538 UCUUGCUCUAUAAACCGUGdTdT 1233 as 556CACGGUUUAUAGAGCAAGAdTdT 1234 s 541 UGCUCUAUAAACCGUGUUAdTdT 1235 as 559UAACACGGUUUAUAGAGCAdTdT 1236 s 532 CAGUGUUCUUGCUCUAUAAdTdT 1237 as 550UUAUAGAGCAAGAACACUGdTdT 1238 s 542 GCUCUAUAAACCGUGUUAGdTdT 1239 as 560CUAACACGGUUUAUAGAGCdTdT 1240 s 134 CCUGGAUGCUGUCCGAGGCdTdT 1241 as 152GCCUCGGACAGCAUCCAGGdTdT 1242 s 119 UCUGAUGGUCAAAGUCCUGdTdT 1243 as 137CAGGACUUUGACCAUCAGAdTdT 1244 s 241 CUGGAGAGCUGCACGGGCUdTdT 1245 as 259AGCCCGUGCAGCUCUCCAGdTdT 1246 s 544 UCUAUAAACCGUGUUAGCAdTdT 1247 as 562UGCUAACACGGUUUAUAGAdTdT 1248 s 530 AACAGUGUUCUUGCUCUAUdTdT 1249 as 548AUAGAGCAAGAACACUGUUdTdT 1250 s 118 CUCUGAUGGUCAAAGUCCUdTdT 1251 as 136AGGACUUUGACCAUCAGAGdTdT 1252 s 140 UGCUGUCCGAGGCAGCCCUdTdT 1253 as 158AGGGCUGCCUCGGACAGCAdTdT 1254 s 239 GUCUGGAGAGCUGCACGGGdTdT 1255 as 257CCCGUGCAGCUCUCCAGACdTdT 1256 s 531 ACAGUGUUCUUGCUCUAUAdTdT 1257 as 549UAUAGAGCAAGAACACUGUdTdT 1258 s 117 CCUCUGAUGGUCAAAGUCCdTdT 1259 as 135GGACUUUGACCAUCAGAGGdTdT 1260 s 131 AGUCCUGGAUGCUGUCCGAdTdT 1261 as 149UCGGACAGCAUCCAGGACUdTdT 1262 s 217 UUGCCUCUGGGAAGACCGCdTdT 1263 as 235GCGGUCUUCCCAGAGGCAAdTdT 1264 s 242 UGGAGAGCUGCACGGGCUCdTdT 1265 as 260GAGCCCGUGCAGCUCUCCAdTdT 1266 s 244 GAGAGCUGCACGGGCUCACdTdT 1267 as 262GUGAGCCCGUGCAGCUCUCdTdT 1268 s 246 GAGCUGCACGGGCUCACCAdTdT 1269 as 264UGGUGAGCCCGUGCAGCUCdTdT 1270 s 399 UACACCAUCGCAGCCCUGCdTdT 1271 as 417GCAGGGCUGCGAUGGUGUAdTdT 1272 s 132 GUCCUGGAUGCUGUCCGAGdTdT 1273 as 150CUCGGACAGCAUCCAGGACdTdT 1274 s 245 AGAGCUGCACGGGCUCACCdTdT 1275 as 263GGUGAGCCCGUGCAGCUCUdTdT 1276 Strand:s = sense; as = antisense; Position:position of 5′ base on transcript (NM_012681.1, SEQ ID NO: 1330)

TABLE 7Chemically modified sense and antisense strand sequences for rat TTR dsRNAsStrand Oligo # Position Sequence (5′ to 3′) SEQ ID NO: s A-32159 115GuccucuGAuGGucAAAGudTdT 1277 as A-32160 133 ACUUUGACcAUcAGAGGACdTdT 1278s A-32745 537 uucuuGcucuAuAAAccGudTdT 1279 as A-32746 555ACGGUUuAuAGAGcAAGAAdTdT 1280 s A-32747 543 cucuAuAAAccGuGuuAGcdTdT 1281as A-32748 561 GCuAAcACGGUUuAuAGAGdTdT 1282 s A-32749 392ucGccAcuAcAccAucGcAdTdT 1283 as A-32750 410 UGCGAUGGUGuAGUGGCGAdTdT 1284s A-32751 538 ucuuGcucuAuAAAccGuGdTdT 1285 as A-32752 556cACGGUUuAuAGAGcAAGAdTdT 1286 s A-32753 541 uGcucuAuAAAccGuGuuAdTdT 1287as A-32754 559 uAAcACGGUUuAuAGAGcAdTdT 1288 s A-32755 532cAGuGuucuuGcucuAuAAdTdT 1289 as A-32756 550 UuAuAGAGcAAGAAcACUGdTdT 1290s A-32757 542 GcucuAuAAAccGuGuuAGdTdT 1291 as A-32758 560CuAAcACGGUUuAuAGAGCdTdT 1292 s A-32759 134 ccuGGAuGcuGuccGAGGcdTdT 1293as A-32760 152 GCCUCGGAcAGcAUCcAGGdTdT 1294 s A-32761 119ucuGAuGGucAAAGuccuGdTdT 1295 as A-32762 137 cAGGACUUUGACcAUcAGAdTdT 1296s A-32763 241 cuGGAGAGcuGcAcGGGcudTdT 1297 as A-32764 259AGCCCGUGcAGCUCUCcAGdTdT 1298 s A-32765 544 ucuAuAAAccGuGuuAGcAdTdT 1299as A-32766 562 UGCuAAcACGGUUuAuAGAdTdT 1300 s A-32767 530AAcAGuGuucuuGcucuAudTdT 1301 as A-32768 548 AuAGAGcAAGAAcACUGUUdTdT 1302s A-32769 118 cucuGAuGGucAAAGuccudTdT 1303 as A-32770 136AGGACUUUGACcAUcAGAGdTdT 1304 s A-32771 140 uGcuGuccGAGGcAGcccudTdT 1305as A-32772 158 AGGGCUGCCUCGGAcAGcAdTdT 1306 s A-32773 239GucuGGAGAGcuGcAcGGGdTdT 1307 as A-32774 257 CCCGUGcAGCUCUCcAGACdTdT 1308s A-32775 531 AcAGuGuucuuGcucuAuAdTdT 1309 as A-32776 549uAuAGAGcAAGAAcACUGUdTdT 1310 s A-32777 117 ccucuGAuGGucAAAGuccdTdT 1311as A-32778 135 GGACUUUGACcAUcAGAGGdTdT 1312 s A-32779 131AGuccuGGAuGcuGuccGAdTdT 1313 as A-32780 149 UCGGAcAGcAUCcAGGACUdTdT 1314s A-32781 217 uuGccucuGGGAAGAccGcdTdT 1315 as A-32782 235GCGGUCUUCCcAGAGGcAAdTdT 1316 s A-32783 242 uGGAGAGcuGcAcGGGcucdTdT 1317as A-32784 260 GAGCCCGUGcAGCUCUCcAdTdT 1318 s A-32785 244GAGAGcuGcAcGGGcucAcdTdT 1319 as A-32786 262 GUGAGCCCGUGcAGCUCUCdTdT 1320s A-32787 246 GAGcuGcAcGGGcucAccAdTdT 1321 as A-32788 264UGGUGAGCCCGUGcAGCUCdTdT 1322 s A-32791 399 uAcAccAucGcAGcccuGcdTdT 1323as A-32792 417 GcAGGGCUGCGAUGGUGuAdTdT 1324 s A-32793 132GuccuGGAuGcuGuccGAGdTdT 1325 as A-32794 150 CUCGGAcAGcAUCcAGGACdTdT 1326s A-32795 245 AGAGcuGcAcGGGcucAccdTdT 1327 as A-32796 263GGUGAGCCCGUGcAGCUCUdTdT 1328 See Table 5 for duplex # (dsRNA name).Strand: s = sense; as = antisense; Position: position of 5′ base ontranscript (NM_012681.1, SEQ ID NO: 1330)

Synthesis of TTR Sequences

TTR sequences were synthesized on MerMade 192 synthesizer at 1 μmolscale. For all the sequences in the list, ‘endolight’ chemistry wasapplied as detailed below.

-   -   All pyrimidines (cytosine and uridine) in the sense strand were        replaced with corresponding 2′-O-Methyl bases (2′ O-Methyl C and        2′-O-Methyl U)    -   In the antisense strand, pyrimidines adjacent to (towards 5′        position) ribo A nucleoside were replaced with their        corresponding 2-O-Methyl nucleosides    -   A two base dTdT extension at 3′ end of both sense and antisense        sequences was introduced    -   The sequence file was converted to a text file to make it        compatible for loading in the MerMade 192 synthesis software

The synthesis of TTR sequences used solid supported oligonucleotidesynthesis using phosphoramidite chemistry. The synthesis of the abovesequences was performed at 1 um scale in 96 well plates. The amiditesolutions were prepared at 0.1M concentration and ethyl thio tetrazole(0.6M in Acetonitrile) was used as activator.

The synthesized sequences were cleaved and deprotected in 96 wellplates, using methylamine in the first step and triethylamine.3HF in thesecond step. The crude sequences thus obtained were precipitated usingacetone: ethanol mix and the pellet were re-suspended in 0.5M sodiumacetate buffer. Samples from each sequence were analyzed by LC-MS andthe resulting mass data confirmed the identity of the sequences. Aselected set of samples were also analyzed by IEX chromatography.

The next step in the process was purification. All sequences werepurified on an AKTA explorer purification system using Source 15Qcolumn. A single peak corresponding to the full length sequence wascollected in the eluent and was subsequently analyzed for purity by ionexchange chromatography.

The purified sequences were desalted on a Sephadex G25 column using AKTApurifier. The desalted TTR sequences were analyzed for concentration andpurity. The single strands were then annealed to form TTR-dsRNA.

Example 2B In Vitro Screening of TTR siRNAs for mRNA Suppression

Human TTR targeting dsRNAs (Table 2) were assayed for inhibition ofendogenous TTR expression in HepG2 and Hep3B cells, using qPCR (realtime PCR) and bDNA (branched DNA) assays to quantify TTR mRNA. RodentTTR targeting dsRNA (Table 5) were synthesized and assayed forinhibition of endogenous TTR expression using bDNA assays in H.4.II.Ecells. Results from single dose assays were used to select a subset ofTTR dsRNA duplexes for dose response experiments to calculate IC50's.IC50 results were used to select TTR dsRNAs for further testing.

Cell Culture and Transfections:

The hepatocyte cell lines HepG2, Hep3B and H.4.II.E cells (ATCC,Manassas, Va.) were grown to near confluence at 37° C. in an atmosphereof 5% CO₂ in Dulbecco's modified Eagle's medium (ATCC) supplemented with10% FBS, streptomycin, and glutamine (ATCC) before being released fromthe plate by trypsinization. H.4.II.E cells were also grown in Earle'sminimal essential medium. Reverse transfection was carried out by adding5 μl of Opti-MEM to 5 μl of siRNA duplexes per well into a 96-well platealong with 10 μl of Opti-MEM plus 0.2 μl of Lipofectamine RNAiMax perwell (Invitrogen, Carlsbad Calif. cat #13778-150) and incubated at roomtemperature for 15 minutes. 80 μl of complete growth media withoutantibiotics containing 4×10⁴ (HepG2), 2×10⁴ (Hep3B) or 2×10⁴ (H.4.II.E)cells were then added. Cells were incubated for 24 hours prior to RNApurification. Single dose experiments were performed at 10 nM finalduplex concentration and dose response experiments were done with 10, 1,0.5, 0.1, 0.05, 0.01, 0.005, 0.001, 0.0005, 0.0001, 0.00005, 0.00001 nM.

Total RNA Isolation Using MagMAX-96 Total RNA Isolation Kit (AppliedBiosystems, Foster City Calif., Part #: AM1830):

Cells were harvested and lysed in 140 nl of Lysis/Binding Solution thenmixed for 1 minute at 850 rpm using and Eppendorf Thermomixer (themixing speed was the same throughout the process). Twenty micro litersof magnetic beads were added into cell-lysate and mixed for 5 minutes.Magnetic beads were captured using magnetic stand and the supernatantwas removed without disturbing the beads. After removing supernatant,magnetic beads were washed with Wash Solution 1 (isopropanol added) andmixed for 1 minute. Beads were captured again and supernatant removed.Beads were then washed with 150 μl Wash Solution 2 (Ethanol added),captured and supernatant was removed. 50 μl of DNase mixture (MagMaxturbo DNase Buffer and Turbo DNase) was then added to the beads and theywere mixed for 10 to 15 minutes. After mixing, 100 μl of RNA RebindingSolution was added and mixed for 3 minutes. Supernatant was removed andmagnetic beads were washed again with 150 μl Wash Solution 2 and mixedfor 1 minute and supernatant was removed completely. The magnetic beadswere mixed for 2 minutes to dry before RNA it was eluted with 50 μl ofwater.

cDNA Synthesis Using ABI High Capacity cDNA Reverse Transcription Kit(Applied Biosystems, Foster City, Calif., Cat #4368813):

A master mix of 2 μl 10× Buffer, 0.8 μl 25×dNTPs, 2 μl Random primers, 1μl Reverse Transcriptase, 1 μl RNase inhibitor and 3.2 μl of H2O perreaction were added into 10 μl total RNA. cDNA was generated using aBio-Rad C-1000 or S-1000 thermal cycler (Hercules, Calif.) through thefollowing steps: 25° C. 10 min, 37° C. 120 min, 85° C. 5 sec, 4° C.hold.

Real Time PCR:

2 μl of cDNA was added to a master mix of 1 μl 18S TaqMan Probe (AppliedBiosystems Cat #4319413E), 1 μl TTR TaqMan probe (Applied Biosystems cat#HS00174914 MO and 10 μl TaqMan Universal PCR Master Mix (AppliedBiosystems Cat #4324018) per well in a MicroAmp Optical 96 well plate(Applied Biosystems cat #4326659). Real time PCR was done in an ABI 7000Prism or an ABI 7900HT Real Time PCR system (Applied Biosystems) usingthe ΔΔ Ct(RQ) assay. All reactions were done in triplicate.

Real time data were analyzed using the ΔΔ Ct method and normalized toassays performed from cells transfected with 10 nM BlockIT fluorescentOligo (Invitrogen Cat #2013) or 10 nM AD-1955 (a control duplex thattargets the non-mammalian luciferase gene) to calculate fold change.

Branched DNA Assays—QuantiGene 1.0 (Panomics, Fremont, Calif. Cat #:QG0004)—Used to Screen Rodent Specific Duplexes

H.4.II.E cells (ATCC) were transfected with 10 nM siRNA. After removingmedia, H.4.II.E were lysed in 100 ul of Diluted Lysis Mixture (a mixtureof 1 volume of Lysis mixture, 2 volume of nuclease-free water and 10 ulof Proteinase-K per ml for the final concentration of 20 mg/ml) thenincubated at 65° C. for 35 minutes. Then, 80 μl of Working Probe Set (amixture of TTR or GAPDH probe) and 20 ul of cell-lysate were added intothe Capture Plate. Capture Plates were incubated at 53° C.±1° C.overnight (approximately 16-20 hrs). Capture Plates were washed 3 timeswith 1× Wash Buffer (a mixture of nuclease-free water, Buffer Component1 and Wash Buffer Component 2), then dried by centrifuging for 1 minuteat 1000 rpm. 100 μl of Amplifier Working Reagent was added into theCapture Plate, which was then sealed and incubated for 1 hour at 46°C.±1° C. Wash and dry steps were repeated after 1 hour of incubation and100 μl of Label Solution Reagent was added. The plate was then washed,dried and 100 μl Substrate (a mixture of Lithium Lauryl Sulfate andSubstrate solution) was added. Capture Plates were placed in theincubator for 30 minutes at 46° C.±1° C. Capture Plates were thenremoved from the incubator and incubated at room temperature for 30minutes. Finally, the Capture Plates were read using the VictorLuminometer (Perkin Elmer, Waltham, Mass.).

Branched DNA Assays—QuantiGene 2.0 (Panomics cat #: QS0011): Used toScreen all Other Duplexes

After a 24 hour incubation at the dose or doses stated, media wasremoved and cells were lysed in 100 ul Lysis Mixture (1 volume lysismixture, 2 volumes nuclease-free water and 10 μl of Proteinase-K/ml fora final concentration of 20 mg/ml) then incubated at 65° C. for 35minutes. 20 μl Working Probe Set (TTR probe for gene target and GAPDHfor endogenous control) and 80 μl of cell-lysate were then added to theCapture Plates. Capture Plates were incubated at 55° C.±1° C. (approx.16-20 hrs). The next day, the Capture Plates were washed 3 times with 1×Wash Buffer (nuclease-free water, Buffer Component 1 and Wash BufferComponent 2), then dried by centrifuging for 1 minute at 240 g. 100 μlof pre-Amplifier Working Reagent was added to the Capture Plates, whichwere sealed with aluminum foil and incubated for 1 hour at 55° C.±1° C.Following a 1 hour incubation, the wash step was repeated, then 100 μlAmplifier Working Reagent was added. After 1 hour, the wash and drysteps were repeated, and 100 μl Label Probe was added. Capture plateswere incubated 50° C.±1° C. for 1 hour. The plates were then washed with1× Wash Buffer and dried, and then 100 μl Substrate was added to theCapture Plates. Capture Plates were read using the SpectraMaxLuminometer (Molecular Devices, Sunnyvale, Calif.) following 5 to 15minutes incubation.

bDNA Data Analysis:

bDNA data were analyzed by (i) subtracting the average background fromeach triplicate sample, (ii) averaging the resultant triplicate GAPDH(control probe) and TTR (experimental probe) values, and then (iii)taking the ratio: (experimental probe-background)/(controlprobe-background).

Results

A summary of the single dose and IC50 results for TTR-dsRNAs (TTRsiRNAs) are presented below in Table 8. Single dose results areexpressed as % TTR mRNA relative to control, assayed in HepG2 cells.IC50s were determined in HepG2 and/or Hep3B cells, as indicated.

TABLE 8 Single dose and IC50 results of in vitro screens of TTR siRNAsSingle Dose at 10 nM % relative to control IC50 (nM) HepG2 HepG2 Hep3BDuplex # qPCR bDNA qPCR bDNA qPCR bDNA AD-18243 50.35 141.53 ND ND ND NDAD-18244 64.26 158.55 ND ND ND ND AD-18245 56.89 107.22 ND ND ND NDAD-18246 10.53 32.51* 0.265 0.086 ND ND AD-18247 125.56 69.57 ND ND NDND AD-18248 127.78 66.97 ND ND ND ND AD-18249 48.77 48.76 ND ND ND NDAD-18250 96.94 86.42 ND ND ND ND AD-18251 170.41 129.15 ND ND ND NDAD-18252 73.52 81.90 ND ND ND ND AD-18253 25.25 61.25 ND ND ND NDAD-18254 95.13 103.96 ND ND ND ND AD-18255 119.46 ND ND ND ND NDAD-18256 42.64 95.67 ND ND ND ND AD-18257 146.25 141.75 ND ND ND NDAD-18258 10.20 13.41* 0.007 0.005 0.004 0.005 AD-18259 9.30 20.91* 0.1020.005 ND ND AD-18260 125.37 81.36 ND ND ND ND AD-18261 14.27 19.40*0.210 ND ND ND AD-18262 84.95 104.05 ND ND ND ND AD-18263 16.32 23.25*0.110 ND ND ND AD-18264 104.18 83.69 ND ND ND ND AD-18265 41.62 64.87 NDND ND ND AD-18266 39.98 110.53 ND ND ND ND AD-18267 149.64 ND ND ND NDND AD-18268 152.93 174.04 ND ND ND ND AD-18269 37.27 92.28 ND ND ND NDAD-18270 99.44 164.75 ND ND ND ND AD-18271 18.89 28.33* 0.503 0.004 NDND AD-18272 128.32 132.58 ND ND ND ND AD-18273 115.78 201.95 ND ND ND NDAD-18274 8.97 20.04* 0.009 0.176 0.036 0.012 AD-18275 4.09 22.25* 0.0260.118 ND ND AD-18276 19.73 45.22* 0.198 0.677 ND ND AD-18277 10.5526.31* 0.121 0.426 ND ND AD-18278 108.86 116.26 ND ND ND ND AD-1827966.59 ND ND ND ND ND AD-18280 103.26 170.52 ND ND ND ND AD-18281 87.98123.88 ND ND ND ND AD-18282 82.47 140.32 ND ND ND ND AD-18283 106.54182.78 ND ND ND ND AD-18284 106.93 151.78 ND ND ND ND AD-18285 26.5860.05* ND 0.089 ND ND AD-18286 109.95 173.66 ND ND ND ND AD-18287 54.23155.45 ND ND ND ND AD-18288 73.52 174.09 ND ND ND ND AD-18289 103.36174.76 ND ND ND ND AD-18290 17.06 52.04* 1.253 0.181 ND ND AD-18291 7.71169.29* 1.304 0.019 ND ND AD-18292 7.51 210.03* 0.604 0.005 ND NDAD-18293 3.61 62.53* 0.078 0.003 ND ND AD-18294 111.53 107.56 ND ND NDND AD-18295 115.88 105.37 ND ND ND ND AD-18296 57.03 38.03 ND ND ND NDAD-18297 87.69 73.87 ND ND ND ND AD-18298 10.39 7.25* 0.455 0.008 ND NDAD-18299 18.79 18.06* 0.895 0.014 ND ND AD-18300 108.70 ND ND ND ND NDAD-18301 114.22 70.50 ND ND ND ND AD-18302 116.19 122.40 ND ND ND NDAD-18303 124.89 ND ND ND ND ND AD-18304 132.99 89.54 ND ND ND NDAD-18305 153.10 ND ND ND ND ND AD-18306 159.22 ND ND ND ND ND AD-18307116.83 84.57 ND ND ND ND AD-18308 156.72 87.80 ND ND ND ND AD-18309113.22 101.97 ND ND ND ND AD-18310 132.33 ND ND ND ND ND AD-18311 161.6892.92 ND ND ND ND AD-18312 103.01 71.17 ND ND ND ND AD-18313 120.6553.26 ND ND ND ND AD-18314 116.33 ND ND ND ND ND AD-18315 115.13 ND NDND ND ND AD-18316 118.73 122.34 ND ND ND ND AD-18317 114.03 121.10 ND NDND ND AD-18318 80.85 122.57 ND ND ND ND AD-18319 119.14 148.87 ND ND NDND AD-18320 22.86 55.43* ND 0.023 0.403 ND AD-18321 6.44 31.56* 0.0010.033 ND ND AD-18322 54.21 100.46 ND ND ND ND AD-18323 6.37 28.71* 0.0050.023 ND ND AD-18324 2.53 15.98* 0.002 0.006 0.005 0.014 AD-18325 2.5211.96* 0.001 0.016 ND ND AD-18326 18.34 43.16* 0.025 0.186 ND NDAD-18327 18.28 13.90* 0.044 0.215 ND ND AD-18328 4.53 26.04* 0.003 0.0040.006 0.006 AD-18329 96.93 131.54 ND ND ND ND AD-18330 11.80 45.18*0.0004 0.010 0.020 ND AD-18331 117.77 163.07 ND ND ND ND AD-18332 11.5335.09* 0.001 0.076 0.065 ND AD-18333 12.24 46.94* 0.001 0.115 0.075 NDAD-18334 16.27 55.28* 0.0004 0.181 1.071 ND AD-18335 53.52 112.80 ND NDND ND AD-18336 6.39 33.00* 0.001 0.112 0.081 ND AD-18337 51.77 105.33 NDND ND ND AD-18338 48.21 102.86 ND ND ND ND AD-18339 6.48 26.56* 0.0040.002 0.018 0.029 AD-18340 4.53 30.76* 0.002 0.002 ND ND AD-18341 31.27100.41 ND ND ND ND AD-18342 7.60 42.89* ND 0.016 0.076 ND AD-18343 3.4217.45* ND 0.001 ND ND AD-18344 75.08 134.31 ND ND ND ND AD-18345 13.6242.75* 0.002 0.013 ND ND AD-18346 59.25 121.10 ND ND ND ND AD-1834791.23 139.54 ND ND ND ND AD-18348 89.95 159.29 ND ND ND ND AD-18349108.01 144.96 ND ND ND ND AD-18350 123.65 125.87 ND ND ND ND AD-18351108.36 104.02 ND ND ND ND AD-18352 87.82 128.72 ND ND ND ND AD-1835314.40 65.77 0.012 0.027 ND ND AD-18354 99.27 123.53 ND ND ND ND AD-18355135.04 150.88 ND ND ND ND AD-18356 100.76 178.96 ND ND ND ND AD-18357125.30 162.85 ND ND ND ND AD-18358 103.15 136.01 ND ND ND ND AD-1835934.74 140.48 ND ND ND ND AD-18360 103.86 146.86 ND ND ND ND AD-18361105.74 152.74 ND ND ND ND AD-18362 106.96 188.22 ND ND ND ND AD-18363124.22 58.46 ND ND ND ND AD-18364 113.75 66.87 ND ND ND ND AD-1844629.73 13.30 ND ND ND ND AD-18447 109.74 53.63 ND ND ND ND AD-18448 22.968.81 ND ND ND ND AD-18449 112.59 50.11 ND ND ND ND AD-18450 89.41 34.89ND ND ND ND AD-18451 74.35 23.88 ND ND ND ND AD-18452 125.25 54.86 ND NDND ND AD-18453 126.98 56.31 ND ND ND ND AD-18454 113.88 52.48 ND ND NDND AD-18455 163.00 48.89 ND ND ND ND AD-18456 15.70 10.52 ND ND ND NDAD-18457 12.86 8.22 ND ND ND ND AD-18458 13.00 7.00 ND ND ND ND AD-1845914.41 10.72 ND ND ND ND AD-18460 121.16 74.87 ND ND ND ND AD-18461100.53 71.87 ND ND ND ND AD-18462 47.75 29.35 ND ND ND ND AD-18463 58.9844.79 ND ND ND ND ND: no data; *indicates result that represents averageof two experiments.

The dose response data used to identify the IC50 for 5 TTR-dsRNAs(AD-18258, AD-18274, AD-18324, AD-18328, and AD-18339), are presented indetail below in Table 9. All siRNAs were determined to have pM IC50s.The IC50 data for dsRNAs in Table 8 is a summary of the data presentedin Table 9 below.

TABLE 9 Dose response data for 5 TTR-dsRNAs % inhibition relative tocontrol AD-1955 Detection Dose of duplex (nM) IC50 Cell type method 10 10.5 0.1 0.05 0.01 0.005 0.001 0.0005 0.0001 0.00005 0.00001 (nM) DuplexAD-18258 HepG2 qPCR 14.4 14.1 16.2 23.9 27.26 40.19 68.46 78.1 74.48104.37 98.28 113.68 0.007 HepG2 bDNA 14.3 14.5 11.1 12.8 18.82 19.7751.21 56.03 63.63 58.35 43.64 51.05 0.005 Hep3B qPCR 11.9 8.62 12.4 16.428.35 30.49 58.36 54.57 81.26 89.43 81.85 101.87 0.004 Hep3B bDNA 7.657.5 11.3 12.6 28.85 27.89 64.57 73.48 72.03 91.44 86.71 89.31 0.005Duplex AD-18274 HepG2 qPCR 6.68 8.45 11.7 24.2 42.08 49.89 56.95 62.9964.47 54.92 67.39 72.67 0.009 HepG2 bDNA 27.5 69 25.2 34.2 73.03 103.4121.57 97.31 154.93 156.7 Nd 152.25 0.176 Hep3B qPCR 7.58 17 15.6 43.942.22 60.55 78.8 77.81 79.97 85.84 86.13 83.99 0.036 Hep3B bDNA 3.774.92 7.51 15 35.21 51.66 72.45 70.12 78.31 77.52 90.72 83.01 0.012Duplex AD-18324 HepG2 qPCR 2.07 2.27 2.74 6.36 8.18 15.23 28.82 52.7990.86 94.72 116.07 98.97 0.002 HepG2 bDNA 14.5 7.88 11.8 15.9 17.2 46.4440.4 91.86 0 95.57 0 52.15 0.006 Hep3B qPCR 2.07 3.48 5.76 16.2 18.7344.54 49.77 68.88 63.48 76.61 74.7 77.83 0.005 Hep3B bDNA 3.48 3.8 5.1515.2 30.84 55.36 74.75 99.39 88.89 110.83 96.55 110.26 0.014 DuplexAD-18328 HepG2 qPCR 5.85 3.97 3.32 5.62 8 16.75 55.01 39.76 122.41102.37 114.02 124.09 0.003 HepG2 bDNA 12.3 10.7 10.7 11.9 20.06 25 69.5257.29 112.28 98.14 142.26 148.92 0.004 Hep3B qPCR 3.17 5.52 11.7 13.827.68 39.58 61.21 61.87 90.51 87.56 106.03 108.72 0.006 Hep3B bDNA 3.083.66 4.19 7.25 21.05 22.1 73.74 63.19 105.55 96.27 105.97 96.46 0.006Duplex AD-18339 HepG2 qPCR 6.27 7.28 Nd 11 15.25 38.69 38.78 71.7 84.0962.2 75.61 85.46 0.004 HepG2 bDNA 15.1 8.14 5.13 6.89 12.17 32.14 42.9864.01 60.76 79.95 81.97 95.43 0.002 Hep3B qPCR 8.3 9.47 13.2 34.5 44.5477.38 81.04 81.41 93.95 81.04 75.61 78.28 0.018 Hep3B bDNA 10.5 9.4311.7 27.1 44.88 72.32 79.88 79.6 87.46 96.53 95.13 89.88 0.029

A summary of the single dose results for rodent specific TTR-dsRNAs (TTRsiRNAs) are presented below in Table 10. Single dose results areexpressed as % TTR mRNA relative to control, assayed in rat H.4.II.Ecells, after transfection of rodent specific TTR siRNAs at 10 nM. Theseresults show that some rodent specific TTR siRNAs are effective insuppressing endogenous rat TTR mRNA in vitro.

TABLE 10 Single dose results of in vitro screen of rodent specificTTR-dsRNAs (TTR siRNAs) Duplex # % Relative to control at 10 nM AD-1852919.83 AD-18530 44.49 AD-18531 6.01 AD-18532 24.06 AD-18533 37.78AD-18534 8.19 AD-18535 10.18 AD-18536 16.13 AD-18537 15.88 AD-1853819.93 AD-18539 49.24 AD-18540 2.99 AD-18541 1.32 AD-18542 6.3 AD-1854316.46 AD-18544 17.55 AD-18545 3.53 AD-18546 2.75 AD-18547 7.01 AD-185485.02 AD-18549 1.61 AD-18550 9.58 AD-18551 7.74 AD-18552 3.74 AD-1855350.39 AD-18554 111.06

Example 3 In Vitro Assay of TTR siRNAs for Induction of TNF-α and IFN-αSecretion

To evaluate potential for immunostimulation, TTR siRNAs were assayed invitro for induction of TNF-α and IFN-α secretion.

Human PBMC were isolated from freshly collected buffy coats obtainedfrom healthy donors (Research Blood Components, Inc., Boston, Mass.) bya standard Ficoll-Hypaque density centrifugation. Freshly isolated cells(1×10⁵/well/100 μl) were seeded in 96-well plates and cultured in RPMI1640 GlutaMax medium (Invitrogen) supplemented with 10% heat-inactivatedfetal bovine serum and 1% antibiotic/antimycotic (Invitrogen).

siRNAs were transfected into PBMC using DOTAP transfection reagent(Roche Applied Science). The DOTAP was first diluted in Opti-MEM(Invitrogen) for 5 minutes before mixing with an equal volume ofOpti-MEM containing the siRNA. siRNA/DOTAP complexes were incubated asspecified by the manufacturer's instructions and subsequently added toPBMC (50 μl/well) which were then cultured for 24 hours. Positive andnegative control siRNAs were included in all assays. AD-5048 was used asa positive control siRNA. AD-5048 corresponds to a sequence that targetshuman Apolipoprotein B (Soutschek et al., 2004) and elicits secretion ofboth IFN-α and TNF-α in this assay. AD-1955, which does not elicit IFN-αand TNF-α secretion in this assay, was used as a negative control siRNA.All siRNAs were used at a final concentration of 133 nM. The ratio ofRNA to transfection reagent was 16.5 pmoles per μg of DOTAP.

Cytokines were detected and quantified in culture supernatants with acommercially available ELISA kit for IFN-α (BMS2161NST) and TNF-α(BMS2231NST), both from Bender MedSystems (Vienna, Austria). TTR siRNAcytokine induction is expressed as percent IFN-α or TNF-α producedrelative to the positive control siRNA AD-5048.

IFN-α and TNF-α stimulation results for a number of TTR siRNAs arepresented in FIG. 1 (mean of quadruplicate wells±SD) and below in Table11 (percentage compared with AD-5048). None of the TTR siRNAs evaluatedinduced significant TNF-α or IFN-α secretion by cultured human PBMCs.

TABLE 11 IFN-α and TNF-α stimulation results for TTR siRNAs Duplex #IFN-α (% of AD-5048) TNF-α (% of AD-5048) AD-18246 0 4 AD-18258 0 0AD-18259 0 0 AD-18261 0 0 AD-18263 0 0 AD-18271 0 0 AD-18274 2 1AD-18275 0 0 AD-18276 0 0 AD-18277 0 0 AD-18285 0 0 AD-18290 0 0AD-18291 0 0 AD-18292 0 0 AD-18293 0 0 AD-18298 0 0 AD-18299 0 0AD-18320 0 0 AD-18321 0 0 AD-18323 0 0 AD-18324 0 0 AD-18325 0 0AD-18326 0 0 AD-18327 0 0 AD-18328 0 0 AD-18330 0 0 AD-18332 1 0AD-18333 0 1 AD-18334 0 1 AD-18336 1 0 AD-18339 0 0 AD-18340 0 0AD-18342 0 0 AD-18343 0 0 AD-18345 0 0 AD-18353 0 0 AD-18448 0 0AD-18456 0 0 AD-18457 0 0 AD-18458 0 0 AD-18459 0 0

The five lead TTR targeting dsRNAs (TTR siRNAs) were selected based onIC50s in the pM range in the human hepatocyte cell lines HepG2 andHep3B, and the absence of immunostimulatory activity. Duplexes withoutany mismatches are more likely to achieve significant knockdown of thetarget transcript than duplexes with mismatches between the oligo andthe mRNA. To better enable interpretation of cross-species toxicologydata and to have the broadest applicability to human patients, duplexesthat have 100% identity in orthologous genes from rat, cynomolgus monkeyand human, and that do not target regions with known polymorphisms aregenerally preferred. The five lead compounds were selected based on IC50in hepatocyte cell lines in the pM range, the absence ofimmunostimulatory activity, specificity to the human TTR transcripts,and absence of known polymorphisms (mutations) in the region of the mRNAtargeted by the duplex. In the case of TTR, no 19 base oligos were foundwith complete identity in human, rat and cynomolgus monkey. A summary ofthese data are presented in Table 12, which also includes information onknown TTR mutations in the region targeted by the duplex andcross-species reactivity.

TABLE 12 Summary of data for five most potent TTR dsRNAs. IC50 IC50(qPCR): (bDNA): nM nM Mutations Duplex # HepG2 HepG2 IFNa/TNFa notcovered Cross-species reactivity AD-18258 0.007 0.005 Negative NoneCyno: 1 mismatch @ position (non-coding 14 A to G region) Rat: nohomology at any position AD-18274 0.009 0.176 Negative Lys70Asn; Cyno:no mismatch Val71Ala; Rat: no homology at any position Ile73Val;Asp74His AD-18324 0.002 0.006 Negative None Cyno: no mismatch(non-coding Rat: no homology at any position region) AD-18328 0.0030.004 Negative None Cyno: no mismatch (non-coding Rat: 7 mismatchesregion) AD-18339 0.004 0.002 Negative None None (non-coding region)

Example 4 In Vivo Reduction of Liver TTR mRNA and Plasma TTR Protein byLNP01-18324, LNP01-18328 and LNP01-18246 in Transgenic Mice

Two TTR siRNAs, AD-18324 and AD-18328, were chosen for in vivoevaluation. These duplexes exhibited potent dose-dependent silencing invitro in hepatocyte cell lines (e.g. HepG2). FIG. 2A and FIG. 2B showthe dose responses in HepG2 cells after transfection with AD-18324 (FIG.2A) or AD-18328 (FIG. 2B) where the doses are expressed in nM on thex-axis and the responses are expressed as fraction TTR mRNA remainingrelative to control, on the y-axis. In HepG2 cells, the IC50s ofAD-18324 and AD-18328 were determined to be 2 pM and 3 pM, respectively.The TTR target sites for both lead dsRNA candidates are in the 3′untranslated region of the TTR mRNA, in a region where there are noreported mutations in the literature.

The sequences of each strand of the two lead candidates are reproducedbelow from the Tables. Strand: s=sense; as=antisense; Position: positionof 5′ base on transcript NM_(—)000371.2.

SEQ ID Duplex # Strand Oligo # Position* Sequence 5′ to 3′ NO: AD-18324s A-32337 509 GGAuuucAuGuAAccAAGAdTdT 1001 AD-18324 as A-32338 527UCUUGGUuAcAUGAAAUCCdTdT 1002 AD-18328 s A-32345 518GuAAccAAGAGuAuuccAudTdT 1009 AD-18328 as A-32346 536AUGGAAuACUCUUGGUuACdTdT 1010

In addition, a rodent cross-reactive TTR dsRNA, AD-18246, was chosen forfurther evaluation in vivo. AD-18246 targets a sequence beginning atposition 88 of the open reading frame, where there are three mutationsreported in the literature. A dose response curve for AD-18246 in HepG2cells is shown in FIG. 3. AD-18246 is substantially less potent thanAD-18324 and AD-18328; the IC50 of AD-18246 was determined to be 265 pM.

AD-18324, AD-18328, and AD-18246 were administered to transgenic miceafter formulation in LNP01. 3-5 month old H129-mTTR-KO/iNOS-KO/hTTRtransgenic mice (mouse transthyretin knock-out/inducible nitric oxidesynthase knock-out/human transthyretin transgenic) were intravenously(IV) administered 200 μl of LNP01-formulated transthyretin-specificsiRNA (AD-18324, AD-18328, or AD-18246), LNP01-formulated control siRNAtargeting the non-mammalian luciferase gene (AD-1955) or PBS via thetail vein at concentrations of 1.0 mg/kg, 3.0 mg/kg, or 6.0 mg/kg forsiRNAs AD-18324 and AD-18328, 3.0 mg/kg for siRNA AD-18246, and 6.0mg/kg for siRNA AD-1955. LNP01 is a lipidoid formulation comprised ofND98, Cholesterol, and PEG-Ceramide C16.

After approximately forty-hours, mice were anesthetized with 200 μl ofketamine, and then exsanguinated by severing the right caudal artery.Whole blood was isolated and plasma was isolated and stored at −80° C.until assaying. Liver tissue was collected, flash-frozen and stored at−80° C. until processing.

Efficacy of treatment was evaluated by (i) measurement of TTR mRNA inliver at 48 hours post-dose, and (ii) measurement of TTR protein inplasma at prebleed and at 48 hours post-dose. TTR liver mRNA levels wereassayed utilizing the Branched DNA assays-QuantiGene 2.0 (Panomics cat#: QS0011). Briefly, mouse liver samples were ground and tissue lysateswere prepared. Liver lysis mixture (a mixture of 1 volume of lysismixture, 2 volume of nuclease-free water and 10 ul of Proteinase-K/mlfor a final concentration of 20 mg/ml) was incubated at 65° C. for 35minutes. 20 μl of Working Probe Set (TTR probe for gene target and GAPDHfor endogenous control) and 80 ul of tissue-lysate were then added intothe Capture Plate. Capture Plates were incubated at 55° C.±1° C. (aprx.16-20 hrs). The next day, the Capture Plate were washed 3 times with 1×Wash Buffer (nuclease-free water, Buffer Component 1 and Wash BufferComponent 2), then dried by centrifuging for 1 minute at 240 g. 100 ulof pre-Amplifier Working Reagent was added into the Capture Plate, whichwas sealed with aluminum foil and incubated for 1 hour at 55° C.±1° C.Following 1 hour incubation, the wash step was repeated, then 100 μl ofAmplifier Working Reagent was added. After 1 hour, the wash and drysteps were repeated, and 100 μl of Label Probe was added. Capture plateswere incubated 50° C.±1° C. for 1 hour. The plate was then washed with1× Wash Buffer, dried and 100 μl Substrate was added into the CapturePlate. Capture Plates were read using the SpectraMax Luminometerfollowing a 5 to 15 minute incubation. bDNA data were analyzed bysubtracting the average background from each triplicate sample,averaging the resultant triplicate GAPDH (control probe) and TTR(experimental probe) values, and then computing the ratio: (experimentalprobe-background)/(control probe-background).

TTR plasma levels were assayed utilizing the commercially available kit“AssayMax Human Prealbumin ELISA Kit” (AssayPro, St. Charles, Mo.,Catalog #EP3010-1) according to manufacturer's guidelines. Briefly,mouse plasma was diluted 1:10,000 in 1× mix diluents and added topre-coated plates along with kit standards, and incubated for 2 hours atroom temperature followed by 5× washes with kit wash buffer. Fiftymicroliters of biotinylated prealbumin antibody was added to each welland incubated for 1 hr at room temperature, followed by 5× washes withwash buffer. Fifty microliters of streptavidin-peroxidase conjugate wasadded to each well and plates were incubated for 30 minutes at roomtemperature followed by washing as previously described. The reactionwas developed by the addition of 50 μl/well of chromogen substrate andincubation for 10 minutes at room temperature with stopping of reactionby the addition of 50 μl/well of stop solution. Absorbance at 450 nm wasread on a Versamax microplate reader (Molecular Devices, Sunnyvale,Calif.) and data were analyzed utilizing the Softmax 4.6 softwarepackage (Molecular Devices).

LNP01-18324 and LNP01-18328 were found to reduce liver TTR mRNA (FIG.4A) and plasma TTR protein (FIG. 4B) levels in a dose-dependent mannerwith IV bolus administration. The mRNA ED50 of LNP01-18328 wasdetermined to be ˜1 mg/kg whereas the ED50 of LNP01-18324 was determinedto be ˜2 mg/kg. The effects of LNP01-18324 and LNP01-18328 werespecific, because the control, LNP01-1955 at 6 mg/kg, did notsignificantly affect liver TTR mRNA levels, as compared with the PBSgroup. LNP01-18324 and LNP01-18328 reduced plasma TTR protein levelsrelative to the PBS group, with potencies that were similar to those onTTR mRNA levels. At 3 mg/kg, LNP01-18246 reduced liver TTR mRNA levelsto a lessor extent than 3 mg/kg LNP01-18324 or LNP01-18328.

These results demonstrate that LNP01-18324 and LNP01-18328, administeredby IV bolus, substantially reduce human TTR mRNA expressed by thetransgenic mouse liver, which results in reduction of human TTR proteinin the circulation.

Example 5 In Vivo Reduction of Wild-Type TTR mRNA in the Non-HumanPrimate Liver by SNALP-18324 and SNALP-18328

To evaluate the efficacy of TTR siRNAs AD-18324 and AD-18328 innon-human primates on liver TTR mRNA levels, the siRNAs were formulatedin SNALP and administered by 15-minute IV infusion. Cynomolgus monkeys(Macaca fascicularis) (2 to 5 kg, 3 animals per group) were administered15-minute IV infusions of SNALP-18324 (0.3, 1.0 or 3.0 mg/kg),SNALP-18328 (0.3, 1 or 3 mg/kg), or SNALP-1955 (3 mg/kg, with negativecontrol siRNA AD-1955 which targets the non-mammalian gene luciferase).At forty-eight hours post-dosing, monkeys were anesthetized with sodiumpentobarbital and exsanguinated. Liver tissue for TTR mRNA determinationwas collected, flash-frozen, and stored at −80° C. until processing.

TTR mRNA levels in the liver were assayed utilizing a custom designedBranched DNA assay, utilizing the QuantiGene1.0 technology. Briefly,monkey liver samples were ground and tissue lysates were prepared. Liverlysis mixture (1 volume lysis mixture, 2 volume nuclease-free water, and10 μl of Proteinase-K/ml for a final concentration of 20 mg/ml) wasincubated at 65° C. for 35 minutes. 20 μl Working Probe Set (TTR probefor gene target and GAPDH for endogenous control) and 80 μltissue-lysate were then added into the Capture Plate. Capture Plateswere incubated at 55° C.±1° C. (approx. 16-20 hrs). The next day, theCapture Plates were washed three times with 1× Wash Buffer(nuclease-free water, Buffer Component 1 and Wash Buffer Component 2),then dried by centrifuging for 1 minute at 240 g. 100 μl ofpre-Amplifier Working Reagent was added into the Capture Plate, whichwas sealed with aluminum foil and incubated for 1 hour at 55° C.±1° C.Following a 1-hour incubation, the wash step was repeated, and then 100μl Amplifier Working Reagent was added. After 1 hour, the wash and drysteps were repeated, and 100 μl Label Probe was added. Capture plateswere incubated 50° C.±1° C. for 1 hour. The plates were then washed with1× Wash Buffer and dried, and then 100 μl Substrate was added into theCapture Plate. Capture Plates were read using the SpectraMax Luminometerfollowing a 5 to 15 minute incubation. bDNA data were analyzed by (i)subtracting the average background from each triplicate sample, (ii)averaging the resultant GAPDH (control probe) and TTR (experimentalprobe) values, and then (iii) taking the ratio: (experimentalprobe-background)/(control probe-background).

The results are shown in FIG. 5. SNALP-18324 and SNALP-18328 reduced TTRmRNA levels in the liver in a dose-dependent manner, compared to thenegative control SNALP-1955. The mRNA ED50s of SNALP-18328 andSNALP-18324 were determined to be ˜0.3 and ˜1 mg/kg, respectively.

These results demonstrate that SNALP-18324 and SNALP-18328 are effectivein suppressing wild-type TTR mRNA in non-human primate liver whenadministered by IV infusion.

Example 6 In Vivo Reduction of Mutant (V30M) TTR mRNA and Protein bySNALP-18328 in the Transgenic Mouse

To evaluate the efficacy of TTR siRNA AD-18328 on mutant (V30M) TTR mRNAin the liver and mutant (V30M) TTR protein in the serum, AD-18328 wasformulated in SNALP and administered by IV bolus to V30M hTTR transgenicmice. 8 to 12-week old V30M hTTR transgenic mice (5 animals/group) wereintravenously (IV) administered 200 μl SNALP-18328 (0.03, 0.3 or 3mg/kg), SNALP-1955 (3 mg/kg, with negative control siRNA AD-1955 whichtargets the non-mammalian gene luciferase), or PBS. Mice used were theMus musculus strain H129-hTTR KO from Institute of Molecular andCellular Biology, Porto, Portugal. Briefly, hTTR H129 transgenic micewere crossed with a H129 endogenous TTR KO mice (null mice to generatethe H129-hTTR transgenic mice, in a null mouse TTR background (Maeda,S., (2003), Use of genetically altered mice to study the role of serumamyloid P component in amyloid deposition. Amyloid Suppl. 1, 17-20).

At 48 hrs post-injection, animals in all five treatment groups weregiven a lethal dose of ketamine/xylazine. Serum samples were collectedand stored at −80° C. until analysis. Liver tissue was collected,flash-frozen and stored at −80° C. until processing.

For TTR mRNA quantitation, frozen liver tissue was ground into powder,and lysates were prepared. TTR mRNA levels relative to those of GAPDHmRNA were determined in the lysates by using a branched DNA assay(QuantiGene Reagent System, Panomics, Fremont, Calif.). Briefly, theQuantiGene assay (Genospectra) was used to quantify mRNA levels intissue sample lysates according to the manufacturer's instructions. Themean level of TTR mRNA was normalized to the mean level of GAPDH mRNAfor each sample. Group means of the normalized values were then furthernormalized to the mean value for the PBS treated group, to obtain therelative level of TTR mRNA expression.

For TTR protein quantitation, serum was assayed using the AssayPro (St.Charles, Mo.) Assaymax PreAlbumin ELISA Kit according to themanufacturer's protocol.

The results are shown in FIG. 6A and FIG. 6B for liver mRNA and serumprotein, respectively. SNALP-18328 treated V30M hTTR transgenic mice hada dose-dependent and significant decrease in liver TTR mRNA levelsrelative to the PBS control group, reaching a maximum reduction of 97%(p<0.001) at 3 mg/kg SNALP-18328, and a 50% reduction (ED50) at ˜0.15mg/kg SNALP-18328. Serum TTR protein was also suppressed in adose-dependent manner, with a maximum reduction of serum TTR protein of99% (p<0.01) (relative to pre-dose levels) at 3 mg/kg SNALP-18328,consistent with the reduction in TTR mRNA levels. SNALP-1955 at 3 mg/kgdid not have a statistically significant effect on either TTR mRNA orprotein levels, compared to PBS.

These results demonstrate that SNALP-18328, when administered IV, isactive in suppressing mutant V30M TTR mRNA in the transgenic mouseliver, which results in reduction of mutant V30M TTR protein in thecirculation.

Example 7 Durability of TTR mRNA and Protein Suppression by SNALP-18328in the Transgenic Mouse

To evaluate the durability of TTR mRNA and protein suppression bySNALP-18328, AD-18328 was formulated in SNALP and administered by IVbolus to V30M hTTR transgenic mice. At various timepoints post-dose,liver TTR mRNA levels and serum TTR protein levels were quantified. 8-to 12-week old V30M hTTR transgenic mice (4 animals/group) wereintravenously (IV) administered 200 μL SNALP-18328 (1 mg/kg) orSNALP-1955 (1 mg/kg, with negative control siRNA AD-1955 which targetsthe non-mammalian gene luciferase). Mice used were Mus musculus strainH129-hTTR KO from Institute of Molecular and Cellular Biology, Porto,Portugal. Briefly, hTTR H129 transgenic mice were crossed with a H129endogenous TTR KO mice (null mice to generate the H129-hTTR transgenicmice, in a null mouse TTR background (Maeda, S., (2003), Use ofgenetically altered mice to study the role of serum amyloid P componentin amyloid deposition. Amyloid Suppl. 1, 17-20). Days 3, 8, 15, or 22post-dose, animals in both treatment groups were given a lethal dose ofketamine/xylazine. Serum samples were collected and stored at −80° C.until analysis. Liver tissue was collected, flash-frozen and stored at−80° C. until processing.

For TTR mRNA quantitation, frozen liver tissue was ground into powder,and lysates were prepared. TTR mRNA levels relative to those of GAPDHmRNA were determined in the lysates by using a branched DNA assay(QuantiGene Reagent System, Panomics, Fremont, Calif.). Briefly, theQuantiGene assay (Genospectra) was used to quantify mRNA levels intissue sample lysates according to the manufacturer's instructions. Themean level of TTR mRNA was normalized to the mean level of GAPDH mRNAfor each sample. Group means of the normalized values were then furthernormalized to the mean value for the PBS treated group, to obtain therelative level of TTR mRNA expression.

For TTR protein quantitation, serum was assayed using the AssayPro (St.Charles, Mo.) Assaymax PreAlbumin ELISA Kit according to themanufacturer's protocol.

The results are shown in FIG. 7A and FIG. 7B for liver mRNA and serumprotein, respectively. A single IV bolus administration of SNALP-18328in the hTTR V30M transgenic mouse resulted in durable inhibition of TTRmRNA levels in the liver and TTR protein levels in the serum. Comparedto the control group (1 mg/ml SNALP-1955), a single IV administration ofSNALP-18328 at 1 mg/kg significantly reduced relative TTR mRNA levels onDays 3, 8, 15 and 22 post-dose by 96% (p<0.001), 90% (p<0.001), 82%(p<0.001) and 73% (p<0.001), respectively, and did not return tobaseline levels at termination of the study (Day 22 post-dose). Proteinlevels also decreased with a maximum reduction of serum TTR of 97%(p<0.001) (relative to SNALP-1955) at Day 3 post-dose. At Days 8, 15,and 22 post-dose, TTR protein levels were suppressed by 72% (p<0.05),32% (p<0.05), and 40% (p<0.001), respectively, relative to SNALP-1955.

These results demonstrate that a single IV administration of SNALP-18328produces durable suppression of target liver mRNA and serum proteinlevels in the V30M hTTR transgenic mouse, with significant reductions ofboth liver TTR mRNA and serum TTR protein at 22 days post-dose.

Example 8 Durability of Serum TTR Protein Suppression by SNALP-18328 inthe Non-Human Primate

To evaluate the durability of serum TTR protein suppression bySNALP-18328, AD-18328 was formulated in SNALP and administered by IVinfusion to non-human primates. At various timepoints post-dose, serumTTR protein levels were quantified.

Cynomolgus monkeys (Macaca fascicularis) (n=5 animals/group forSNALP-18328 groups and n=3 animals/group for SNALP-1955 and PBS groups)were administered a 15-minute IV infusion of SNALP-18328 (0.3, 1 or 3mg/kg), SNALP-1955 (3 mg/kg) with negative control siRNA AD-1955 whichtargets the non-mammalian gene luciferase), or PBS. At Days 0, 1, 2, 3,4, 5, 7, 10, and 14 of the dosing phase, serum samples were collectedand stored at −80° C. until analysis.

Western blot analysis was used to evaluate TTR protein levels in serumsamples. Serum samples from each group were pooled and diluted 1:1 withLaemmli sample buffer (β-mercaptoethanol was added at a 1:20 dilution).The samples were heated at 95° C. for 10 minutes. 12.5 μl of each samplewas loaded in each lane of a 10-20% Criterion (Biorad, Hercules, Calif.)prep gel and separated by SDS-PAGE at 120V for 1.5 hrs, then transferredto a nitrocellulose membrane using a semi-dry system at 15V for 1 hour.The membrane was blocked overnight at 4° C. in LiCOR (Lincoln, Nebr.)blocking buffer diluted 1:1 with 1×PBS. The blot was probed first withprimary antibodies (goat anti-TTR from Santa Cruz (Santa Cruz, Calif.)at a dilution of 1:1000 diluted in LiCOR blocking buffer/PBS on a rockerfor 1 hr at room temperature. Blots were washed 4× with PBS+0.2% Tween20 (10 minutes per wash). The fluorescent labeled secondary antibodies(anti-goat 680 nm from Invitrogen (Carlsbad, Calif.) were added at adilution of 1:10,000 in LiCOR blocking buffer/PBS and the blot wasincubated for 1 hour at room temperature. After incubation, blots werewashed 4× with PBS+0.2% Tween 20 followed by one wash with 1×PBS. TheLi-COR's Odyssey Infrared Imaging System was used to detect the proteinbands. TTR monomer migrates at 15 kDa.

The results are shown in FIG. 8. Serum TTR protein levels showed adose-dependent reduction with 1 or 3 mg/kg SNALP-18328, as compared topre-dose (Day 0) levels. The duration of suppression, following a singleIV administration of SNALP-18328 is at least 14 days after 1 or 3 mg/kgSNALP-18328 treatment.

These results demonstrate that a single IV administration of SNALP-18328produces durable suppression of TTR protein in the circulation in thenon-human primate (Macaca fascicularis), with significant reduction ofTTR protein at 14 days post-dose.

Example 9 In Vivo Reduction of Mutant (V30M) TTR in Peripheral Tissuesby SNALP-18328 in the Transgenic Mouse

To evaluate the efficacy of SNALP-18328 in reducing TTR in peripheraltissues, hTTR V30M/HSF-1 knock-out mice were evaluated withimmunohistochemical staining for TTR. Two-month old hTTR V30M/HSF-1knock-out mice (Maeda, S., (2003), Use of genetically altered mice tostudy the role of serum amyloid P component in amyloid deposition.Amyloid Suppl. 1, 17-20) were administered an IV bolus of 3 mg/kgSNALP-18328 (12 animals), 3 mg/kg SNALP-1955 (with negative controlsiRNA AD-1955 which targets the non-mammalian gene luciferase, 4animals), or PBS (4 animals) once every two weeks for a total of fourdoses on days 0, 14, 28, and 42. TTR liver mRNA levels andTTR-immunoreactivity in multiple peripheral tissues were evaluated at 8weeks post-first dose on day 56.

Mice were anesthetised with 1 mg/kg medetomidine, and given a lethaldose of ketamine. Tissues and organs of interest were collected. Forimmunohistochemistry, esophagus (E), stomach (S), intestine (duodenum(I1) and colon (I4)), nerve (N) and dorsal root ganglia (D) were fixedin neutral buffered formalin and embedded in paraffin. For TTRdetection, rabbit anti-human TTR primary antibody (1:1000, DAKO,Denmark), and anti-rabbit biotin-conjugated secondary antibody (1:20Sigma, USA) were followed by extravidin labelling (1:20, Sigma, USA) inorder to stain for the TTR protein. The reaction was developed with3-amino-9-ethyl carbaxole, AEC (Sigma, USA). Semi-quantitative analysisof immunohistochemical slides was performed using Scion image quantprogram that measures the area occupied by the substrate reaction colorand normalizes this value to the total image area. Mean values of %occupied area are displayed with the corresponding standard deviation.Each animal tissue was evaluated in four different areas. The presenceof human TTR in parasympathetic ganglia of the stomach and intestine wasstudied by double immunofluorescent staining with rabbit anti-human TTR(1:1000, DAKO, Denmark) and mouse anti-PGP9.5 (1:40, Serotec, USA) asthe primary antibodies; secondary antibodies were, respectively:anti-rabbit Alexa Fluor 488 (Molecular probes, UK) and goat anti-mouseAlexa Fluor 568 (Molecular probes, UK). Slides were mounted withvectashield (Vector) and visualized in a Zeiss Cell Observer Systemmicroscope (Carl Zeiss, Germany) equipped with filters for FITC andrhodamine.

The results are graphed in FIG. 9. In contrast with PBS and SNALP-1955treated animals, SNALP-18328 treated animals had a significant reductionof TTR-immunoreactivity in all tissues examined (esophagus (E), stomach(S), intestine (duodenum (I1) and colon (I4)), nerve (N) and dorsal rootganglia (D).

These results demonstrate that SNALP-18328 administration to hTTRV30M/HSF-1 knock-out mice causes a significant reduction of TTR proteinin peripheral tissues and organs, including esophagus, stomach,intestine (duodenum and colon), nerve, and dorsal root ganglion.

Example 10 In Vivo Reduction of Wild-Type TTR mRNA in the Non-HumanPrimate Liver by XTC-SNALP-18328

To evaluate the efficacy of the novel lipid nanoparticle formulationXTC-SNALP for delivery of siRNA in non-human primate, TTR siRNA AD-18328was formulated in XTC-SNALP (XTC-SNALP-18328) and administered by15-minute IV infusion, and liver TTR mRNA was quantified. Cynomolgusmonkeys (Macaca fascicularis) were administered 15-minute IV infusionsof XTC-SNALP-18328 (0.03, 0.1, 0.3 or 1 mg/kg) or XTC-SNALP-1955 (1mg/kg, with negative control siRNA AD-1955 which targets thenon-mammalian gene luciferase). At forty-eight hours post-dosing,monkeys were anesthetized with sodium pentobarbital and exsanguinated.Liver tissue for TTR mRNA determination was collected, flash-frozen, andstored at −80° C. until processing. Methods used for TTR mRNAquantitation in liver tissue were similar to those described in Example5 above.

The results are shown in FIG. 10. XTC-SNALP-18328 reduced TTR mRNAlevels in the liver in a dose-dependent manner, compared to the negativecontrol XTC-SNALP-1955. The mRNA ED50 was determined to be ˜0.1 mg/kgXTC-SNALP-18328.

These results demonstrate that XTC-SNALP-18328 is effective insuppressing wild-type TTR mRNA in non-human primate liver whenadministered by IV infusion.

Example 11 In Vivo Reduction of Wild-Type TTR mRNA in the Non-HumanPrimate Liver by LNP09-18328 and LNP11-18328

To evaluate the efficacy of two novel lipid nanoparticle formulations,LNP09 and LNP11, for delivery of siRNA in non-human primate, TTR siRNAAD-18328 was formulated in LNP09 (LNP09-18328) or LNP11 (LNP11-18328),and administered by 15-minute IV infusion, and liver TTR mRNA and serumTTR protein levels were assayed. Cynomolgus monkeys (Macacafascicularis) were administered 15-minute IV infusions of LNP09-18328(0.03, 0.1, or 0.3 mg/kg), LNP11-18328 (0.03, 0.1, or 0.3 mg/kg), orPBS. Liver biopsy samples were collected at 48 hrs post-dosing,flash-frozen, and stored at −80° C. until processing. Serum wascollected before dosing (pre-bleed), and on Days 1, 2, 4, 7, 14, 21 and28 post-dosing and stored at −80° C. until processing. Methods used forTTR mRNA quantitation in liver tissue and serum TTR protein evaluationwere similar to those described in Examples 5 and 8 above.

The results are shown in FIG. 11A for mRNA, and in FIG. 11B and FIG. 11Cfor protein. LNP09-18328 and LNP11-18328 treated animals showed adose-dependent decrease in TTR mRNA levels in the liver, reaching amaximum reduction at 0.3 mg/kg of ˜85% (LNP09-18328) and ˜90%(LNP11-18328) mRNA relative to the PBS control. The mRNA ED50 wasdetermined to be ˜0.02 mg/kg for both LNP09-18328 and LNP11-18328. AtDay 7 post-dosing, serum samples also exhibited a dose-dependentreduction of TTR protein for 0.1 and 0.3 mg/kg LNP09-18328 andLNP11-18328, compared to PBS control levels. FIG. 11C shows a decreasein TTR protein levels with a 0.3 mg/kg dose of LNP09-18328 thatpersisted over at least 28 days post-dosing, as compared to the PBScontrol group and as compared with the pre-bleed samples.

These results demonstrate that LNP09-18328 and LNP11-18328 are effectivein suppressing wild-type TTR mRNA in non-human primate liver andwild-type TTR protein in the circulation, when administered by IVinfusion. Furthermore, the suppression with LN09-18328 is durable,persisting for at least 28 days following the IV infusion.

Example 12 Synthesis of TTR Tiled Sequences

A set of TTR duplexes (“tiled duplexes”) were designed that targeted theTTR gene near the target region of AD-18328, which targets the human TTRgene starting at nucleotide 628 of NM_(—)000371.3.

In the examples below, the numbering representing the position of the 5′base of an siRNA on the transcript is based on NM_(—)000371.3 (FIG. 12;SEQ ID NO:1331). In the examples shown above, the numbering for siRNAtargeting human siRNA was based on NM_(—)000371.2 (FIG. 13A).NM_(—)000371.3 extends the sequence of the 5′ UTR by 110 bases comparedto NM_(—)000371.2, as shown in FIG. 14. Thus, as an example, thestarting position of AD-18328 is 628 on NM_(—)000371.3 and 518 onNM_(—)000371.2 (FIG. 14).

TTR tiled sequences were synthesized on MerMade 192 synthesizer at 1umol scale. For all the sequences in the list, ‘endolight’ chemistry wasapplied as detailed below.

-   -   All pyrimidines (cytosine and uridine) in the sense strand        contained 2′-O-Methyl bases (2′ O-Methyl C and 2′-O-Methyl U)    -   In the antisense strand, pyrimidines adjacent to (towards 5′        position) ribo A nucleoside were replaced with their        corresponding 2-O-Methyl nucleosides    -   A two base dTdT extension at 3′ end of both sense and anti sense        sequences was introduced    -   The sequence file was converted to a text file to make it        compatible for loading in the MerMade 192 synthesis software

Synthesis, Cleavage and Deprotection:

The synthesis of TTR sequences used solid supported oligonucleotidesynthesis using phosphoramidite chemistry. The synthesis of thesequences was performed at 1 um scale in 96 well plates. The amiditesolutions were prepared at 0.1M concentration and ethyl thio tetrazole(0.6M in Acetonitrile) was used as activator. The synthesized sequenceswere cleaved and deprotected in 96 well plates, using methylamine in thefirst step and fluoride reagent in the second step. The crude sequenceswere precipitated using acetone:ethanol (80:20) mix and the pellet werere-suspended in 0.2M sodium acetate buffer. Samples from each sequencewere analyzed by LC-MS to confirm the identity, UV for quantificationand a selected set of samples by IEX chromatography to determine purity.

Purification and Desalting:

TTR tiled sequences were purified on AKTA explorer purification systemusing Source 15Q column. A column temperature of 65 C was maintainedduring purification. Sample injection and collection was performed in 96well (1.8 mL-deep well) plates. A single peak corresponding to the fulllength sequence was collected in the eluent. The purified sequences weredesalted on a Sephadex G25 column using AKTA purifier. The desalted TTRsequences were analyzed for concentration (by UV measurement at A260)and purity (by ion exchange HPLC). The single strands were thensubmitted for annealing.

TTR Single Strands and Duplexes:

A detailed list of TTR tiled duplexes and corresponding single strands(sense and antisense) are shown in the table below (Table 13).

TABLE 13 TTR tiled duplexes and corresponding single strands Duplex Posi- Oligo  SEQ ID # tion # Strand Sequence (5′ to 3″)  NO: AD-18323618 A-32335 S GGGAuuucAuGuAAccAAGdTdT 1332 A-32336 ASCUUGGUuAcAUGAAAUCCCdTdT 1333 AD-18324 619 A-32337 SGGAuuucAuGuAAccAAGAdTdT 1334 A-32338 AS UCUUGGUuAcAUGAAAUCCdTdT 1335AD-23000 620 A-42927 S GAuuucAuGuAAccAAGAGdTdT 1336 A-42928 ASCUCUUGGUuAcAUGAAAUCdTdT 1337 AD-23001 621 A-42929 SAuuucAuGuAAccAAGAGudTdT 1338 A-42930 AS ACUCUUGGUuAcAUGAAAUdTdT 1339AD-23002 622 A-42931 S uuucAuGuAAccAAGAGuAdTdT 1340 A-42932 ASuACUCUUGGUuAcAUGAAAdTdT 1341 AD-23003 623 A-42933 SuucAuGuAAccAAGAGuAudTdT 1342 A-42934 AS AuACUCUUGGUuAcAUGAAdTdT 1343AD-18325 624 A-32339 S ucAuGuAAccAAGAGuAuudTdT 1344 A-32340 ASAAuACUCUUGGUuAcAUGAdTdT 1345 AD-23004 625 A-42935 ScAuGuAAccAAGAGuAuucdTdT 1346 A-42936 AS GAAuACUCUUGGUuAcAUGdTdT 1347AD-18326 626 A-32341 S AuGuAAccAAGAGuAuuccdTdT 1348 A-32342 ASGGAAuACUCUUGGUuAcAUdTdT 1349 AD-18327 627 A-32343 SuGuAAccAAGAGuAuuccAdTdT 1350 A-32344 AS UGGAAuACUCUUGGUuAcAdTdT 1351AD-23005 628 A-42937 S uAAccAAGAGuAuuccAuudTdT 1352 A-42938 ASAAUGGAAuACUCUUGGUuAdTdT 1353 AD-23006 629 A-42939 SAAccAAGAGuAuuccAuuudTdT 1354 A-42940 AS AAAUGGAAuACUCUUGGUUdTdT 1355AD-23007 631 A-42941 S AccAAGAGuAuuccAuuuudTdT 1356 A-42942 ASAAAAUGGAAuACUCUUGGUdTdT 1357 AD-23008 632 A-42943 SccAAGAGuAuuccAuuuuudTdT 1358 A-42944 AS AAAAAUGGAAuACUCUUGGdTdT 1359AD-23009 633 A-42945 S cAAGAGuAuuccAuuuuuAdTdT 1360 A-42946 ASuAAAAAUGGAAuACUCUUGdTdT 1361 AD-23010 634 A-42947 SAAGAGuAuuccAuuuuuAcdTdT 1362 A-42948 AS GuAAAAAUGGAAuACUCUUdTdT 1363AD-23011 635 A-42949 S AGAGuAuuccAuuuuuAcudTdT 1364 A-42950 ASAGuAAAAAUGGAAuACUCUdTdT 1365 AD-23012 636 A-42951 SGAGuAuuccAuuuuuAcuAdTdT 1366 A-42952 AS uAGuAAAAAUGGAAuACUCdTdT 1367AD-23013 637 A-42953 S AGuAuuccAuuuuuAcuAAdTdT 1368 A-42954 ASUuAGuAAAAAUGGAAuACUdTdT 1369 AD-23014 638 A-42955 SGuAuuccAuuuuuAcuAAAdTdT 1370 A-42956 AS UUuAGuAAAAAUGGAAuACdTdT 1371AD-23015 639 A-42957 S uAuuccAuuuuuAcuAAAGdTdT 1372 A-42958 ASCUUuAGuAAAAAUGGAAuAdTdT 1373 AD-23016 640 A-42959 SAuuccAuuuuuAcuAAAGcdTdT 1374 A-42960 AS GCUUuAGuAAAAAUGGAAUdTdT 1375AD-23017 641 A-42961 S uuccAuuuuuAcuAAAGcAdTdT 1376 A-42962 ASUGCUUuAGuAAAAAUGGAAdTdT 1377 AD-23018 642 A-42963 SuccAuuuuuAcuAAAGcAGdTdT 1378 A-42964 AS CUGCUUuAGuAAAAAUGGAdTdT 1379AD-23019 643 A-42965 S ccAuuuuuAcuAAAGcAGudTdT 1380 A-42966 ASACUGCUUuAGuAAAAAUGGdTdT 1381 AD-23020 644 A-42967 ScAuuuuuAcuAAAGcAGuGdTdT 1382 A-42968 AS cACUGCUUuAGuAAAAAUGdTdT 1383AD-23021 645 A-42969 S AuuuuuAcuAAAGcAGuGudTdT 1384 A-42970 ASAcACUGCUUuAGuAAAAAUdTdT 1385 AD-23022 646 A-42971 SuuuuuAcuAAAGcAGuGuudTdT 1386 A-42972 AS AAcACUGCUUuAGuAAAAAdTdT 1387AD-23023 647 A-42973 S uuuuAcuAAAGcAGuGuuudTdT 1388 A-42974 ASAAAcACUGCUUuAGuAAAAdTdT 1389 AD-23024 648 A-42975 SuuuAcuAAAGcAGuGuuuudTdT 1390 A-42976 AS AAAAcACUGCUUuAGuAAAdTdT 1391AD-23025 649 A-42977 S uuAcuAAAGcAGuGuuuucdTdT 1392 A-42978 ASGAAAAcACUGCUUuAGuAAdTdT 1393 AD-23026 650 A-42979 SuAcuAAAGcAGuGuuuucAdTdT 1394 A-42980 AS UGAAAAcACUGCUUuAGuAdTdT 1395AD-23027 651 A-42981 S AcuAAAGcAGuGuuuucAcdTdT 1396 A-42982 ASGUGAAAAcACUGCUUuAGUdTdT 1397 AD-23028 652 A-42983 ScuAAAGcAGuGuuuucAccdTdT 1398 A-42984 AS GGUGAAAAcACUGCUUuAGdTdT 1399AD-18330 653 A-32349 S uAAAGcAGuGuuuucAccudTdT 1400 A-32350 ASAGGUGAAAAcACUGCUUuAdTdT 1401 AD-23029 654 A-42985 SAAAGcAGuGuuuucAccucdTdT 1402 A-42986 AS GAGGUGAAAAcACUGCUUUdTdT 1403AD-23030 655 A-42987 S AAGcAGuGuuuucAccucAdTdT 1404 A-42988 ASUGAGGUGAAAAcACUGCUUdTdT 1405 AD-23031 656 A-42989 SAGcAGuGuuuucAccucAudTdT 1406 A-42990 AS AUGAGGUGAAAAcACUGCUdTdT 1407AD-18328 628 A-32345 S GuAAccAAGAGuAuuccAudTdT 1408 A-32346 ASAUGGAAuACUCUUGGUuACdTdT 1409 Strand: s = sense; as = antisense;Position: position of 5′ base on transcript (NM_000371.3, SEQ ID NO:1331).

Example 13 In Vitro Screening of TTR Tiled siRNAs

Tiled TTR duplexes were assayed in Hep3B cells for inhibition ofendogenous TTR expression using real time PCR assays.

Cell culture and transfection: Hep3B cells (ATCC, Manassas, Va.) weregrown to near confluence at 37° C. in an atmosphere of 5% CO₂ in Eagle'sMinimum Essential Medium (EMEM, ATCC) supplemented with 10% FBS,streptomycin, and glutamine (ATCC) before being released from the plateby trypsinization. Reverse transfection was carried out by adding 5 μlof Opti-MEM to 5 μl of each siRNA in individual wells of a 96-wellplate. To this 10 μl of Opti-MEM plus 0.2 μl of Lipofectamine RNAiMaxwas added per well (Invitrogen, Carlsbad Calif. cat #13778-150) and themixture was incubated at room temperature for 15 minutes. 80 μl ofcomplete growth media described above, but without antibiotic containing2.0×10⁴ Hep3B cells were then added. Cells were incubated for 24 hoursprior to RNA purification. Experiments were performed at 0.1 or 10 nMfinal duplex concentration.

Total RNA isolation using MagMAX-96 Total RNA Isolation Kit (AppliedBiosystems, Foster City Calif., part #: AM1830): Cells were harvestedand lysed in 140 μl of Lysis/Binding Solution then mixed for 1 minute at850 rpm using and Eppendorf Thermomixer (the mixing speed was the samethroughout the process). Twenty micro liters of magnetic beads andLysis/Binding Enhancer mixture were added into cell-lysate and mixed for5 minutes. Magnetic beads were captured using magnetic stand and thesupernatant was removed without disturbing the beads. After removingsupernatant, magnetic beads were washed with Wash Solution 1(isopropanol added) and mixed for 1 minute. Beads were capture again andsupernatant removed. Beads were then washed with 150 μl Wash Solution 2(Ethanol added), captured and supernatant was removed. 50 μl of DNasemixture (MagMax turbo DNase Buffer and Turbo DNase) was then added tothe beads and they were mixed for 10 to 15 minutes. After mixing, 100 μlof RNA Rebinding Solution was added and mixed for 3 minutes. Supernatantwas removed and magnetic beads were washed again with 150 μl WashSolution 2 and mixed for 1 minute and supernatant was removedcompletely. The magnetic beads were mixed for 2 minutes to dry beforeRNA was eluted with 50 μl of water.

cDNA synthesis using ABI High capacity cDNA reverse transcription kit(Applied Biosystems, Foster City, Calif., Cat #4368813): A master mix of2 μl 10× Buffer, 0.8 μl 25×dNTPs, 2 μl Random primers, 1 μl ReverseTranscriptase, 1 μl RNase inhibitor and 3.2 μl of H2O per reaction wereadded into 10 μl total RNA. cDNA was generated using a Bio-Rad C-1000 orS-1000 thermal cycler (Hercules, Calif.) through the following steps:25° C. 10 min, 37° C. 120 min, 85° C. 5 sec, 4° C. hold.

Real time PCR: 2 μl of cDNA were added to a master mix containing 0.5 μlGAPDH TaqMan Probe (Applied Biosystems Cat #4326317E), 0.5 μl TTR TaqManprobe (Applied Biosystems cat #HS00174914 MO and 10 μl Roche ProbesMaster Mix (Roche Cat #04887301001) per well in a LightCycler 480 384well plate (Roche cat #0472974001). Real time PCR was done in aLightCycler 480 Real Time PCR machine (Roche). Each duplex was tested intwo independent transfections and each transfection was assayed induplicate.

Real time data were analyzed using the ΔΔCt method. Each sample wasnormalized to GAPDH expression and knockdown was assessed relative tocells transfected with the non-targeting duplex AD-1955. Table 14 showsthe knockdown of TTR using the siRNAs. Data are expressed as the percentof message remaining relative to cells targeted with AD-1955.

Many but not all tiled TTR-dsRNAs, targeting TTR near the target ofAD-18328, reduced TTR mRNA by at least 70% when transfected into Hep3Bcells at 0.1 nM.

TABLE 14 Inhibition of TTR by tiled dsRNA targeting TTR near target ofAD-18328. % message % SD % message % SD Duplex # remaining 0.1 nM 0.1 nMremaining 10 nM 10 nM AD-18323 6.7 1.90 1.7 0.02 AD-18324 1.8 0.58 0.90.10 AD-23000 5.5 0.93 2.1 0.87 AD-23001 15.2 4.89 4.9 1.74 AD-23002 3.11.12 1.4 0.55 AD-23003 17.3 3.13 1.7 0.06 AD-18325 1.5 0.27 1.4 0.66AD-23004 9.0 0.15 10.5 0.96 AD-18326 22.0 1.85 7.6 0.78 AD-18327 11.62.64 9.6 1.67 AD-18328 1.1 0.70 0.6 0.16 AD-23005 0.8 0.31 0.6 0.21AD-23006 1.5 0.46 1.2 0.43 AD-23007 2.4 0.91 1.9 0.46 AD-23008 0.6 0.100.8 0.26 AD-23009 1.0 0.13 0.9 0.22 AD-23010 60.1 15.66 66.2 22.71AD-23011 56.5 16.99 53.6 4.70 AD-23012 7.7 2.36 7.7 3.25 AD-23013 7.00.64 8.0 1.06 AD-23014 0.7 0.01 0.6 0.10 AD-23015 15.4 0.25 16.5 7.07AD-23016 27.1 0.37 6.7 1.80 AD-23017 4.5 1.26 1.4 0.40 AD-23018 44.69.45 7.5 1.09 AD-23019 2.2 0.68 0.8 0.10 AD-23020 52.7 6.45 29.7 1.17AD-23021 95.4 16.16 45.0 3.00 AD-23022 70.1 3.01 60.8 12.11 AD-23023 2.71.12 1.8 0.07 AD-23024 1.7 0.30 1.8 0.33 AD-23025 64.2 13.21 10.5 1.34AD-23026 1.9 0.15 1.9 0.78 AD-23027 2.5 0.21 1.6 0.49 AD-23028 6.7 4.411.2 0.50 AD-18330 6.0 0.56 5.7 1.15 AD-23029 4.5 0.47 1.6 0.10 AD-230303.9 0.25 3.3 0.84 AD-23031 3.4 0.78 1.7 0.02

Example 14 Evaluation of Infusion Duration on Efficacy of a SingleIntravenous Administration of SNALP-18534 in Sprague-Dawley Rats

Objectives

To determine the effect of infusion duration on efficacy of a single IVinfusion of SNALP-18534 on liver TTR mRNA levels in Sprague-Dawley rats.

TABLE 15 Abbreviations and definitions used SNALP-18534 Rodenttransthyretin specific siRNA formulated in SNALP SNALP-1955Non-mammalian luciferase specific siRNA formulated in SNALP

The sequences of the sense and antisense strands of AD-18534 arereproduced below from the tables above:

SEQ Oligo Posi- ID Strand # tion Sequence 5′ to 3′ NO: s A-32755 532cAGuGuucuuGcucuAuAAdTdT 1289 as A-32756 550 UuAuAGAGcAAGAAcACUGdTdT 1290

Study Materials

Test Article(s)

SNALP-18534 is comprised of an siRNA targeting rodent TTR mRNA(AD-18534), formulated in stable nucleic acid lipid particles (SNALP)for delivery to target tissues. The SNALP formulation (lipid particle)consists of a novel amino lipid (DLinDMA), a PEGylated lipid(mPEG2000-C-DMA), a neutral lipid (DPPC) and cholesterol. The ratio oflipid:nucleic acid in the SNALP formulation is approximately 5.8:1(w:w). SNALP-1955 contains an siRNA targeting the non-mammalianluciferase mRNA, is formulated with the identical lipid particle asSNALP-18534, and serves as a non-pharmacologically active control. Doselevels are expressed as mg/kg based on the weight of siRNA content.

Study Design & Procedures

Animals and Test Article Administration:

The study was comprised of 9 groups of Sprague-Dawley rats (4males/group). The animals were allowed to have at least a 2 dayacclimation period before the study and all animals were 7 weeks old atthe initiation of dosing. The dose administered was calculated basedupon body weight data collected prior to dosing on Day 1. The test andcontrol articles were administered as a single 15-minute, 1-hour,2-hour, or 3-hour IV infusion via the tail vein using a 24G ¾″ cannulasealed with a Baxter Injection Site septum connected via 27G Terumobutterfly needle to a Baxter AS40A Syringe Pump. The dose volume was 3ml/kg, the infusion rate was 12 ml/kg/hr, and animals were freely movingin the cages during dosing. Rats were divided into nine treatment groupsand administered a single IV infusion of SNALP-18534, SNALP-1955, or PBSas shown in Table 16:

TABLE 16 Test Animal Dosage Groups Group N Test Article InfusionDuration Dose A 4 PBS 15 minute — B 4 PBS  3 hour — C 4 SNALP-1955  1hour 1 mg/kg D 4 SNALP-1955  2 hour 1 mg/kg E 4 SNALP-1955  3 hour 1mg/kg F 4 SNALP-18534 15 minute 1 mg/kg G 4 SNALP-18534  1 hour 1 mg/kgH 4 SNALP-18534  2 hour 1 mg/kg I 4 SNALP-18534  3 hour 1 mg/kg

Tissue Collection and RNA Isolation:

On Day 0, animals were anesthetized by isofluorane inhalation andpre-dosing blood samples were collected into serum separator tubes byretro-orbital bleed. The blood samples were allowed to clot at roomtemperature for approximately 30 minutes prior to centrifugation at 4°C. Serum samples were then stored at −80° C. until analysis wasperformed. On Day 3, animals in all nine treatment groups were given alethal dose of ketamine/xylazine. Blood was collected via caudal venacava into serum separation tubes, and then allowed to clot at roomtemperature for approximately 30 minutes prior to centrifugation at 4°C. Serum samples were stored at −80° C. until analysis was performed.Liver tissue was harvested and snap frozen on dry ice. Frozen livertissue was ground and tissue lysates were prepared for liver mRNAquantitation.

TTR mRNA Quantitation:

TTR mRNA levels relative to those of GAPDH mRNA were determined in thelysates by using a branched DNA assay (QuantiGene Reagent System,Panomics, Fremont, Calif.). Briefly, the QuantiGene assay (Genospectra)was used to quantify mRNA levels in tissue sample lysates according tothe manufacturer's instructions. The mean level of TTR mRNA wasnormalized to the mean level of GAPDH mRNA for each sample.

To obtain the relative level of TTR mRNA expression, group mean valuesfor SNALP-1955 and SNALP-18534 treated groups with 15-minute, 1 hour and2 hour infusion durations were then normalized to the mean value for thePBS treated group with 15-minute infusion whereas group mean values forSNALP-1955 and SNALP-18534 treated groups with 3 hour infusion durationwere then normalized to the mean value for the PBS treated group with 3hour infusion duration.

Results

As shown in FIG. 16, a single IV infusion of 1 mg/kg SNALP-18534 withdifferent infusion durations of 15 minutes to 3 hours results incomparable inhibition of liver TTR mRNA levels measured two days afterdosing. A single IV infusion of 1 mg/kg SNALP-18534 also showed durableTTR downregulation over 29 days following a single 15 minute IVinfusion, as compared to SNALP-1955 control (data not shown). Comparedto the PBS-treated group, a single 15-minute, 1-hour, 2-hour, or 3-hourIV infusion of SNALP-18534 at 1 mg/kg significantly reduced relative TTRmRNA expression levels by 94% (p<0.001), 94% (p<0.001), 92% (p<0.001)and 93% (p<0.001), respectively. Specificity of SNALP-18534 activity isdemonstrated by lack of significant target inhibition by SNALP-1955administration via 1-hour, 2-hour, or 3-hour IV infusion at the samedose level.

Conclusions

This study demonstrates that varying the infusion duration from 15minutes to up to 3 hours does not affect the efficacy of a single IVadministration of 1 mg/kg SNALP-18534 in rats, as assessed by reductionof TTR mRNA levels in the liver.

Example 15 In Vivo Reduction of Wild-Type TTR mRNA in the Rat Liver byLNP07-18534 and LNP08-18534

To evaluate the efficacy of 2 novel lipid nanoparticle formulations,LNP07 and LNP08, for delivery of siRNA in the rat, the rodent-specificTTR siRNA, AD-18534, was formulated in LNP07 (LNP07-18534) or LNP08(LNP08-18534), and administered by 15-minute IV infusion, and liver TTRmRNA was quantified. Sprague-Dawley rats (4 animals per group) wereadministered 15-minute IV infusions of LNP07-18534 (0.03, 0.1, 0.3 or 1mg/kg), LNP08-18534 (0.01, 0.03 or 0.1 mg/kg), or LNP07-1955 (1 mg/kg)or LNP08-1955 (0.1 mg/kg) containing the negative control siRNA AD-1955which targets the non-mammalian gene luciferase. Forty-eight hourslater, animals were euthanized and liver tissue was collected,flash-frozen and stored at −80° C. until processing.

For TTR mRNA quantitation, frozen liver tissue was ground into powder,and lysates were prepared. TTR mRNA levels relative to those of GAPDHmRNA were determined in the lysates by using a branched DNA assay(QuantiGene Reagent System, Panomics, Fremont, Calif.). Briefly, theQuantiGene assay (Genospectra) was used to quantify mRNA levels intissue sample lysates according to the manufacturer's instructions. Themean level of TTR mRNA was normalized to the mean level of GAPDH mRNAfor each sample. Group means of the normalized values were then furthernormalized to the mean value for the PBS treated group, to obtain therelative level of TTR mRNA expression.

The results are shown in FIG. 17. LNP07-18534 reduced TTR mRNA levels inthe liver in a dose-dependent manner, with 94% suppression of TTR mRNAat 1 mg/kg. The effect was specific, since the negative controlLNP07-1955 at 1 mg/kg did not significantly affect TTR mRNA levelscompared to the PBS control. The mRNA ED50 was determined to be ˜0.05mg/kg LNP07-18534. LNP08-18534 reduced TTR mRNA levels in the liver in adose-dependent manner, with 86% suppression of TTR mRNA at 0.1 mg/kg.The effect was specific, since the negative control LNP08-1955 at 0.1mg/kg did not significantly affect TTR mRNA levels compared to the PBScontrol. The mRNA ED50 was determined to be ˜0.02 mg/kg LNP08-18534.

These results demonstrate that LNP07-18534 and LNP08-18534 are effectivein suppressing wild-type TTR mRNA in the rat liver when administered byIV infusion, and that LNP07 and LNP08 are effective formulations fordelivering siRNA to the liver.

Example 16 Reduction of TTR Liver mRNA by a Single IntravenousAdministration of LNP09-18534 or LNP11-18534 in Sprague-Dawley Rats

Objective:

To evaluate the efficacy of two novel lipid nanoparticle (LNP)formulations for delivery of the rodent TTR-specific siRNA, AD-18534 inthe Sprague-Dawley rat for reducing endogenous (wild type) liver TTRmRNA levels. Rats were intravenously dosed via a 15 minute infusion witheither 0.01, 0.03, 0.1, or 0.3 mg/kg LNP09-18534, LNP11-18534, orphosphate buffered saline (PBS) and TTR liver mRNA levels were assayedat 48 hrs post-treatment.

Material and Methods:

LNP09 formulation: (XTC/DSPC/Chol/PEG₂₀₀₀-C14)=50/10/38.5/1.5 mol %;Lipid:siRNA˜11:1. LNP11 formulation:(MC3/DSPC/Chol/PEG₂₀₀₀-C14)=50/10/38.5/1.5 mol %; Lipid:siRNA˜11.1

Tissue collection and RNA isolation: On Day 3, animals in all treatmentgroups were given a lethal dose of ketamine/xylazine. Blood wascollected via caudal vena cava into serum separation tubes, and thenallowed to clot at room temperature for approximately 30 minutes priorto centrifugation at 4° C. Serum samples were stored at −80° C. untilfor future analysis. Liver tissues were harvested and snap frozen on dryice. Frozen liver tissue was ground and tissue lysates were prepared forliver mRNA quantitation.

TTR mRNA Quantitation: TTR mRNA levels relative to those of GAPDH mRNAwere determined in the lysates by using a branched DNA assay (QuantiGeneReagent System, Panomics, Fremont, Calif.). Briefly, the QuantiGeneassay (Genospectra) was used to quantify mRNA levels in tissue samplelysates according to the manufacturer's instructions. The mean level ofTTR mRNA was normalized to the mean level of GAPDH mRNA for each sample.Group mean values were then normalized to the mean value for the PBStreated group, to obtain the relative level of TTR mRNA expression.

Results:

As shown in FIG. 18, in contrast with PBS treated animals, LNP09-18534and LNP11-18534 treated animals had a significant dose-dependentdecrease in TTR mRNA levels in the liver, reaching maximum reduction of˜90% mRNA reduction for both LNP09 and LNP11 formulated groups, relativeto PBC control group at 0.3 mg/kg, and a dose achieving 50% reduction(ED₅₀) of <0.03 mg/kg for LNP11-18534 and <0.1 mg/kg for LNP09-18534.

Conclusions

This study demonstrates that a single 15 minute IV infusion ofLNP09-18534 or LNP11-18534 in Sprague-Dawley rats results in adose-dependent reduction of liver TTR mRNA. These data demonstrate theefficacy of LNP09-18328 and LNP11-18328 in reducing endogenouslyexpressed (wild type) TTR mRNA with ED50 levels of <0.03 and <0.1 mg/kgfor LNP11-18534 and LNP09-18534, respectively.

Example 17 Inhibition of TTR in Humans

A human subject is treated with a dsRNA targeted to a TTR gene toinhibit expression of the TTR gene to treat a condition.

A subject in need of treatment is selected or identified. The subjectcan have a liver disorder, transthyretin amyloidosis, and/or atransplanted liver.

The identification of the subject can occur in a clinical setting, orelsewhere, e.g., in the subject's home through the subject's own use ofa self-testing kit.

At time zero, a suitable first dose of an anti-TTR siRNA is administeredto the subject. The dsRNA is formulated as described herein. After aperiod of time following the first dose, e.g., 7 days, 14 days, and 21days, the subject's condition is evaluated, e.g., by measuring liverfunction. This measurement can be accompanied by a measurement of TTRexpression in said subject, and/or the products of the successfulsiRNA-targeting of TTR mRNA. Other relevant criteria can also bemeasured. The number and strength of doses are adjusted according to thesubject's needs.

After treatment, the subject's tumor growth rate is lowered relative tothe rate existing prior to the treatment, or relative to the ratemeasured in a similarly afflicted but untreated subject.

We claim:
 1. A method of inhibiting TTR expression in a cell, the methodcomprising: (a) contacting the cell with a double-stranded ribonucleicacid (dsRNA) for inhibiting expression of transthyretin (TTR), whereinthe dsRNA comprises a sense strand and an antisense strand, theantisense strand comprising a region complementary to an mRNA encodingtransthyretin (TTR), wherein the region of complementarity comprises SEQID NO:170 and each strand of the dsRNA is 19, 20, 21, 22, 23, or 24nucleotides in length; and (b) maintaining the cell produced in step (a)for a time sufficient to obtain degradation of the mRNA transcript of aTTR gene, thereby inhibiting expression of the TTR gene in the cell. 2.The method of claim 1, wherein the method is performed in vitro.
 3. Themethod of claim 1, wherein the method is performed in vivo.
 4. Themethod of claim 1, wherein the region of complementarity consists of SEQID NO:170.
 5. The method of claim 1, wherein the sense strand consistsof SEQ ID NO:449 and the antisense strand consists of SEQ ID NO:450. 6.The method of claim 1, wherein the sense strand consists of SEQ IDNO:729 and the antisense strand consists of SEQ ID NO:730.
 7. The methodof claim 1, wherein the sense strand consists of SEQ ID NO:1009 and theantisense strand consists of SEQ ID NO:1010 and the DsRnA is formulatedin a lipid formulation.
 8. The method of claim 1, wherein each strand is21 nucleotides in length.
 9. The method of claim 1, wherein the dsRNAcomprises at least one modified nucleotide.
 10. The method of claim 1,wherein the dsRNA comprises at least one modified nucleotide chosen fromthe group of: a 2′-O-methyl modified nucleotide, a nucleotide comprisinga 5′-phosphorothioate group, a terminal nucleotide linked to acholesteryl derivative or dodecanoic acid bisdecylamide group, a2′-deoxy-2′-fluoro modified nucleotide, a 2′-deoxy-modified nucleotide,a locked nucleotide, an abasic nucleotide, 2′-amino-modified nucleotide,2′-alkyl-modified nucleotide, morpholino nucleotide, a phosphoramidate,and a non-natural base comprising nucleotide.
 11. The method of claim 1,wherein the dsRNA comprises at least one 2′-O-methyl modifiednucleotide.
 12. The method of claim 1, wherein the dsRNA is conjugatedto a ligand.
 13. The method of claim 1, wherein the dsRNA is formulatedin a lipid formulation.
 14. The method of claim 1, wherein the dsRNA isformulated in a lipid formulation comprising MC3.
 15. The method ofclaim 1, wherein contacting the cell with the dsRNA results in at leastone of the following: a) about 95% inhibition of TTR mRNA expression asmeasured by a real time PCR assay, wherein the cell is a HepG2 cell or aHep3B cell, and the dsRNA concentration is 10 nM; b) about 74%inhibition of TTR mRNA expression as measured by a branched DNA assay,wherein the cell is a HepG2 cell or a Hep3B cell and the dsRNAconcentration is 10 nM; c) the dsRNA has an IC50 of less than 10 pM in aHepG2 cell and the dsRNA concentration is 10 nM; d) the dsRNA has anED50 of about 1 mg/kg; e) the dsRNA reduces TTR expression by 98.9% asmeasured by real-time PCR in a Hep3B cell and the dsRNA concentration is0.1 nM; f) the dsRNA reduces TTR expression by 99.4% as measured byreal-time PCR in a Hep3B cell and the dsRNA concentration is 10 nM. 16.A method of treating a disorder mediated by TTR expression comprisingadministering to a human in need of such treatment a therapeuticallyeffective amount of a double-stranded ribonucleic acid (dsRNA) forinhibiting expression of transthyretin (TTR), wherein the dsRNAcomprises a sense strand and an antisense strand, the antisense strandcomprising a region complementary to an mRNA encoding transthyretin(TTR), wherein the region of complementarity comprises SEQ ID NO:170 andeach strand of the dsRNA is 19, 20, 21, 22, 23, or 24 nucleotides inlength, wherein the disorder is a transthyretin amyloidosis selectedfrom the group consisting of familial amyloidotic polyneuropathy (FAP),familial amyloidotic cardiomyopathy (FAC), leptomeningeal/CNSamyloidosis, senile systemic amyloidosis (SSA) and senile cardiacamyloidosis (SCA).
 17. The method of claim 16, wherein the dsRNA isadministered to the human at about 0.01, 0.1, 0.3, 0.5, 1.0, 2.5, or 5.0mg/kg.
 18. The method of claim 16, wherein the dsRNA is administered tothe human at about 1.0 mg/kg.
 19. The method of claim 16, wherein thedsRNA is formulated in a lipid formulation.
 20. The method of claim 16,wherein the dsRNA is formulated in a lipid formulation comprising MC3.21. The method of claim 16, wherein the human has a liver disorder. 22.The method of claim 16, wherein the human is further provided a livertransplant.
 23. The method of claim 16, wherein administration of thedsRNA results in at least one of the following: a) reduction of TTR mRNAby about 80% in human liver, wherein the therapeutic amount is 3 mg/kg;b) no immunostimulatory activity in the human as measured by IFN-alphaand TNF-alpha ELISA assays; c) reduction of liver TTR mRNA levels byabout 97% or serum TTR protein levels by about 90%, wherein thetherapeutic amound is 6 mg/kg; d) reduction of liver TTR mRNA levelsand/or serum TTR protein levels up to 22 days, wherein therapeuticamount is 6 mg/kg or 3 mg/kg or e) suppression of serum TTR proteinlevels up to day 14 post-treatment wherein therapeutic amount is 1 mg/kgor 3 mg/kg.
 24. The method of claim 16, wherein the dsRNA is formulatedin a lipid formulation comprising MC3 and administration of the dsRNAresults in at least one of the following: a) reduction of TTR mRNAlevels by about 85 to 90% at a therapeutic amount of 0.3 mg/kg, relativeto a PBC control group or b) reduction TTR mRNA levels by about 50% at atherapeutic amount 0.1 mg/kg, relative to a PBC control group or c)reduction TTR protein levels in a dose-dependent manner relative to aPBC control group as measured by a western blot or d) suppression ofserum TTR protein levels up to day 14 post-treatment when thetherapeutic amount is 1 mg/kg or 3 mg/kg.
 25. The method of claim 1,wherein the sense strand consists of SEQ ID NO:1009 and the antisensestrand consists of SEQ ID NO:1010 and the dsRNA is lipid formulated in aformulation comprising MC3.
 26. The method of claim 16, wherein thesense strand consists of SEQ ID NO:1009 and the antisense strandconsists of SEQ ID NO:1010 and the dsRNA is lipid formulated in aformulation comprising MC3.
 27. A method of treating familialamyloidotic polyneuropathy (FAP) comprising administering to a human inneed of such treatment a double-stranded ribonucleic acid (dsRNA)comprising a sense strand and an antisense strand, the sense strandconsisting of SEQ ID NO:1009 and the antisense strand consisting of SEQID NO:1010, wherein the dsRNA is in a formulation comprising thecationic lipid MC3 and the dsRNA is administered at a dose of 0.3 mg/kg.28. The method of claim 16, wherein the dsRNA is administeredintraveneously.
 29. The method of claim 6, wherein the dsRNA isformulated in a lipid formulation.
 30. The method of claim 6, whereinthe dsRNA is formulated in a lipid formulation comprising MC3.